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Furman S, Zeevi YY. Multidimensional gain control in image representation and processing in vision. Biol Cybern 2015; 109:179-202. [PMID: 25413338 DOI: 10.1007/s00422-014-0634-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
A generic model of automatic gain control (AGC) is proposed as a general framework for multidimensional automatic contrast sensitivity adjustment in vision, as well as in other sensory modalities. We show that a generic feedback AGC mechanism, incorporating a nonlinear synaptic interaction into the feedback loop of a neural network, can enhance and emphasize important image attributes, such as curvature, size, depth, convexity/concavity and more, similar to its role in the adjustment of photoreceptors and retinal network sensitivity over the extremely high dynamic range of environmental light intensities, while enhancing the contrast. We further propose that visual illusions, well established by psychophysical experiments, are a by-product of the multidimensional AGC. This hypothesis is supported by simulations implementing AGC, which reproduce psychophysical data regarding size contrast effects known as the Ebbinghaus illusion, and depth contrast effects. Processing of curvature by an AGC network illustrates that it is an important mechanism of image structure pre-emphasis, which thereby enhances saliency. It is argued that the generic neural network of AGC constitutes a universal, parsimonious, unified mechanism of neurobiological automatic contrast sensitivity control. This mechanism/model can account for a wide range of physiological and psychophysical phenomena, such as visual illusions and contour completion, in cases of occlusion, by a basic neural network. Likewise, and as important, biologically motivated AGC provides attractive new means for the development of intelligent computer vision systems.
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Affiliation(s)
- S Furman
- Department of Electrical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel,
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Furman S, Sadkowska-Todys M. Yersiniosis in Poland in 2011. Przegl Epidemiol 2013; 67:221-339. [PMID: 24040721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The aim of this study is to assess the epidemiology of yersiniosis in Poland in 2011 compared to previous years. MATERIAL AND METHODS We reviewed surveillance data published in the annual bulletin "Infectious diseases and poisonings in Poland" from 2006 to 2011 (MP Czarkowski et al., NIH and GIS) and individual yersiniosis case reports from 2011 sent by the Sanitary-Epidemiological Stations. Additionally, we use data from the Department of Demographic Surveys in Central Statistical Office. RESULTS In Poland in 2011 a total of 257 yersiniosis cases were reported including 238 cases of intestinal and 19 cases of extraintestinal yersiniosis; 74% of patients were hospitalized. The incidence rate was 0.67 per 100,000 inhabitants. No deaths related to the disease were reported. The most affected group in intestinal infections were children younger than 4 (63% of all cases); symptoms usually involved diarrhea (87%), fever (76%), abdominal pain (47%) and vomiting (31%). Extraintestinal form of infection was less common than in 2010 (27 cases) and usually involved symptoms from the osteoarticular system, noted in 79% of patients (15 cases). Similarly to previous year (2010) most cases of yersiniosis were reported from Mazowieckie province (91), and the least from the Podlaskie province (1). Serological types of Yersinia enterocolitica were identified in 102 cases (39.7%): serotype O8 (56.8%), O3 (41%) and O9 (> 2%). There was one household outbreak involving 4 people. CONCLUSIONS Since 2006 in Poland in some areas of the country, occurrence of endemic infections caused by a type O8 is observed. A large percentage (60.3%) of unknown Yersinia serotypes is a consequence, that physicians do not always request serotyping. Additionally, the relatively low number of reported cases of extraintestinal yersiniosis in Poland may suggest underreporting, especially by rheumatological hospitals.
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Affiliation(s)
- Sylwia Furman
- Department of Epidemiology, National Institute of Public Health - National Institute of Hygiene, Warsaw
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Sadkowska-Todys M, Furman S, Czarkowski MP. [Salmonellosis in Poland in 2010]. Przegl Epidemiol 2012; 66:259-266. [PMID: 23101214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this study is to present the epidemiology of salmonellosis in Poland in 2010. MATERIAL AND METHODS The study was based on data from: "the Infectious diseases and poisonings in Poland 2010", information from laboratories based in sanitary stations, the forms of outbreaks investigations conducted by sanitary stations and data from Demographic Surveys Departament based in the Central Statistical Office. All cases were classified according to the case definition used by surveillance. RESULTS A total of9 732 salmonellosis cases were reported in Poland. Among them 8 549 cases were intestinal and 183 were extraintestinal. The incidence rate was 25.5 per 100 000 inhabitants. Over 95% of cases met the criteria for a confirmed case. The number of registered cases was higher than in the previous two years, despite this an overall decreasing trend was observed in the number of cases of salmonellosis in Poland. Cases of salmonellosis occurred primarily among children under 5-years old. There were no deaths reported due to salmonellosis. There is still a high percentage, about 70%, hospital admissions of people infected with zoonotic Salmonella. The percentage of hospitalization in outbreaks is almost two and a half times lower -29%. In 2010, 189 outbreaks caused by Salmonella were reported, affecting 1 662 people (almost 18% of all reported cases of intestinal salmonellosis). Most were small family outbreaks. Still the most common etiologic agent in Poland is S. Enteritidis. When compared with previous years, in 2010 there was an increase in the number of cases caused by S. Mbandaka, S. Infantis and S. Virchow. The number of screening tests for carriers among food handlers decreased by over 10% however the percentage diagnosed with positive result increased from 0.3% to 0.5%. CONCLUSIONS Human salmonellosis is still a significant public health problem in Poland. The very high percentage (70%) of hospitalization, persisting for many years indicates that diagnosis and reporting ofsalmonellosis in Poland is mainly among severe cases. This allows to conclude that the incidence of salmonellosis in Poland is largely under-diagnosis and under-reported.
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Affiliation(s)
- Małgorzata Sadkowska-Todys
- Zakład Epidemiologii, Narodowego Instytutu Zdrowia Publicznego - Państwowego Zakładu Higieny w Warszawie
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Furman S, Sadkowska-Todys M. [Yersiniosis in Poland in 2010]. Przegl Epidemiol 2012; 66:249-253. [PMID: 23101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
MATERIAL AND METHODS The study was based on data from: the "Infectious diseases and poisonings in Poland" bulletins published annually between 2005-2010 (MP Czarkowski i in., PZH i GIS), individual case interviews conducted by sanitary stations and data from Demographic Surveys Departament based in the Central Statistical Office. Analysis of the incidence of yersiniosis in the country during 2010 was based on data on clinical symptoms associated with the disease, age groups, the number of cases in different provinces and the serotypes of Yersinia which were isolated. RESULTS A total of 233 yersiniosis cases were reported in 2010 in Poland. The incidence rate was 0.61 per 100 000 inhabitants. In this year 206 cases of intestinal yersiniosis and 27 cases of extraintestinal yersiniosis were notified. No yersiniosis related deaths were reported. Approximately 76% of patients were hospitalized. The most common clinical symptoms of intestinal yersiniosis cases were: diarrhea (82%), high temperature (72%), abdominal pain (39%) and vomiting (34%). The most common symptom of the extraintestinal form of yersiniosis was discomfort to part of the osteoarticular system, which occurred in 59% of patients. The highest incidence rate of intestinal yersiniosis was among children in 0-4 years old. The largest number of yersiniosis cases were reported in Mazowieckie voivodeship, while the least number of cases were reported in Podlaskie and Swietokrzyskie voivodeships. In 2010 only one outbreak of yersiniosis was reported. Three serological types of Yersinia enterocolitica were isolated: 03 (71.2%), 08 (26.3%) and 09 (2.5%). AIM The aim of this study is to present the epidemiology of intestinal and extraintestinal yersiniosis in Poland in 2010. CONCLUSIONS A very large percentage (65.6%) of isolated strains of Yersinia were not serotyped. Yersinia serotype 08 remains very common serotype reported, despite a decline in 2010 in the number of cases notified. The high percentage of hospitalization points that patients with gastrointestinal symptoms are relatively rare direct to routine laboratory diagnostic of Yersinia infection.
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Affiliation(s)
- Sylwia Furman
- Zakład Epidemiologii, Narodowego Instytutu Zdrowia Publicznego - Państwowego Zakładu Higieny w Warszawie
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Han ZJ, Yick S, Levchenko I, Tam E, Yajadda MMA, Kumar S, Martin PJ, Furman S, Ostrikov K. Controlled synthesis of a large fraction of metallic single-walled carbon nanotube and semiconducting carbon nanowire networks. Nanoscale 2011; 3:3214-3220. [PMID: 21701743 DOI: 10.1039/c1nr10327j] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Controlled synthesis of both single-walled carbon nanotube and carbon nanowire networks using the same CVD reactor and Fe/Al(2)O(3) catalyst by slightly altering the hydrogenation and temperature conditions is demonstrated. Structural, bonding and electrical characterization using SEM, TEM, Raman spectroscopy, and temperature-dependent resistivity measurements suggest that the nanotubes are of a high quality and a large fraction (well above the common 33% and possibly up to 75%) of them are metallic. On the other hand, the carbon nanowires are amorphous and semiconducting and feature a controlled sp(2)/sp(3) ratio. The growth mechanism which is based on the catalyst nanoisland analysis by AFM and takes into account the hydrogenation and temperature control effects explains the observed switch-over of the nanostructure growth modes. These results are important to achieve the ultimate control of chirality, structure, and conductivity of one-dimensional all-carbon networks.
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Affiliation(s)
- Z J Han
- Plasma Nanoscience Centre Australia (PNCA), CSIRO Materials Science and Engineering, Lindfield, New South Wales, 2070, Australia
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Werbińska-Sienkiewicz B, Rosińska M, Furman S. [HIV and AIDS in Poland in 2009]. Przegl Epidemiol 2011; 65:289-295. [PMID: 21913478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In total 939 HIV cases were diagnosed in Poland in 2009 (2.46 per 100,000 population), constituting a 10% increase comparing to 2008 and 33% increase comparing to the median number in 2003-2007. The total number of incident AIDS cases in 2009 registered up to the end of 2010 was 107 (incidence 0.28 per 100,000 population). There were 42 death of AIDS patients in 2009 registered up to the end of 2010. Among the newly diagnosed HIV cases an increase of the share of infections acquired through heterosexual contact (up to 7% of all cases and 36% of cases with known transmission route) and homosexual contact between men (up to 6,7% of all cases and 34% of cases with known transmission route) were observed as compared to 2008, which reflects significant changes in HIV epidemiology in Poland, where the epidemic was for many years driven by injecting drug use. Across the country HIV infection is the most frequently detected among people aged 30 to 39 years (69.8%) and among males (76.6%). In comparison to 2008, the proportion of reports without information about the possible route of transmission increased. Furthermore, the percentage of late presenters, as defined by time between HIV and AIDS diagnoses of less than 3 months, is still high (56.1% of AIDS cases), suggesting that an important proportion of AIDS incidence could be prevented by improving testing rates. The largest group among patients with AIDS are also males and people aged 30 to 39 years. 40.2% of them were probably infected through injecting drugs.
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Furman S, Napiórkowska A, Sadkowska-Todys M. [Yersiniosis in Poland in 2009]. Przegl Epidemiol 2011; 65:235-238. [PMID: 21913466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The total number of 326 yersiniosis cases were reported in 2009 in Poland. The incidence rate was 0.85 per 100 000 inhabitants. In this year 288 cases of intestinal yersiniosis and 38 cases of extraintensinal yersiniosis were notified. There were no deaths could be due to infection with Yersinia. About 76% of patients were hospitalized. The most common clinical symptoms of intestinal yersiniosis cases were diarrhea (86%), high temperature (79%), abdominal pain (42%) and vomiting (37%). The most common symptom of extraintensinal form of yersiniosis was discomfort on the part of the osteoarticular system, which occurred in 58% of patients. In 2009 there were no reported outbreaks ofyersiniosis. Serological types of Yersinia enterocolitica isolated in 128 cases. Half of them were Y enterocolitica serotype 03 but there were also 59 cases caused by Y enterocolitica serotype 08.
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Affiliation(s)
- Sylwia Furman
- Zakład Epidemiologii Narodowego Instytutu Zdrowia Publicznego--Państwowego Zakładu Higieny w Warszawie
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Furman S, Alpert JS, Cohn JN, Timmis GC. Management of potential conflict of interest during publication and presentation. J Card Fail 2001; 7:367-8. [PMID: 11782863 DOI: 10.1054/jcaf.2001.30189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Implantation of a cardiac pacemaker should be in the tissue plane deep to the subcutaneous tissue (i.e., between the fatty layer and the pectoralis fascia of the chest wall). Five patients with pacemaker implants between the cutis and the subcutaneous fat presented months later with chronic, unremitting, and often excruciating pain. The pulse generator in each case seemed excessively superficial and displaced, appeared too large for its known size, and was seemingly fixed to the overlying skin with exquisite sensitivity to light touch by a garment or palpation. Each had multiple consultations and treatments for pain, all without effect other than the temporary relief of local anesthesia. In three patients with obvious large subcutaneous fatty layers, the pulse generator was markedly superficial. Wound cultures were sterile in each case. Correction consisted of operative repositioning of the pulse generator into the readily developed subcutaneous tissue plane. In each patient, total and permanent relief of pain was achieved. Subcuticular positioning of permanent pacemaker pulse generators causes chronic pain that is readily relieved by operative repositioning of the pulse generator in the proper tissue plane.
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Affiliation(s)
- S Furman
- Montefiore Medical Center, Bronx, New York 10467-2409, USA.
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Ashur-Fabian O, Giladi E, Furman S, Steingart RA, Wollman Y, Fridkin M, Brenneman DE, Gozes I. Vasoactive intestinal peptide and related molecules induce nitrite accumulation in the extracellular milieu of rat cerebral cortical cultures. Neurosci Lett 2001; 307:167-70. [PMID: 11438390 DOI: 10.1016/s0304-3940(01)01954-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nanomolar concentrations of vasoactive intestinal peptide (VIP), picomolar concentrations of stearyl-norleucine17-VIP (SNV) and femtomolar concentrations of NAPVSIPQ (NAP), an 8-amino-acid peptide derived from the VIP-responsive activity-dependent neuroprotective protein, provide broad neuroprotection. In rat cerebral cortical cultures, 10(-16)-10(-7) M NAP increased intracellular cyclic guanosine monophosphate (cGMP) (2.5-4-fold) and 10(-10) M NAP increased extracellular nitric oxide (NO) by 60%. In the same culture system, VIP and SNV (at micromolar concentrations) increased extracellular NO by 45-55%. The NAP dose required for cGMP increases correlated with the dose providing neuroprotection. However, the concentrations of NAP, SNV and VIP affecting NO production did not match the neuro-protective doses. Thus, NO may mediate part of the cell-cell interaction and natural maintenance activity of VIP/SNV/NAP, while cGMP may mediate neuroprotection.
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Affiliation(s)
- O Ashur-Fabian
- Department of Clinical Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
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Affiliation(s)
- S Furman
- Albert Einstein College of Medicine, Bronx, New York, USA.
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Abstract
Coordinated regulation of actin cytoskeletal dynamics is critical to growth cone movement. The intracellular molecules calmodulin and profilin actively regulate actin-based motility and participate in the signaling pathways used to steer growth cones. Here we show that in the developing Drosophila embryo, calmodulin and profilin convey complimentary information that is necessary for appropriate growth cone advance. Reducing calmodulin activity by expression of a dominant inhibitor (KA) stalls axon extension of pioneer neurons within the CNS, while a partial loss of profilin function decreases extension of motor axons in the periphery. Yet, surprisingly, when calmodulin and profilin are simultaneously reduced, the ability of both CNS pioneer axons and motor axons to extend beyond the choice points is restored. In the CNS, at the time when growth cones must decide whether to cross or not to cross the midline, a reduction in calmodulin and/or roundabout signaling causes axons to cross the midline inappropriately. These inappropriate crossings are suppressed when profilin activity is simultaneously reduced. Interestingly, the mutual suppression of calmodulin and profilin activity requires a minimal level of profilin. In KA combinations with profilin null alleles, defects in axon extension and midline guidance are synergistically enhanced rather than suppressed. Together, our data indicate that the growth cone must coordinate the activity of both calmodulin and profilin in order to advance past selected choice points, including those dictating midline crossovers.
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Affiliation(s)
- Y S Kim
- Department of Biological Sciences, Wayne State University, Detroit, MI 48202, USA
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Hauser R, Hayes D, Parsonnet V, Furman S, Epstein A, Hayes J, Saksena S, Irwin M, Almquist A, Cannom D, Gross J, Kallinen L. Feasibility and initial results of an Internet-based pacemaker and ICD pulse generator and lead registry. Pacing Clin Electrophysiol 2001; 24:82-7. [PMID: 11227975 DOI: 10.1046/j.1460-9592.2001.00082.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The medical community has no independent source of timely information regarding the performance of pacemaker and ICD pulse generators and leads. Accordingly, the authors established an Internet-based registry of pacemaker and ICD pulse generator and lead failures (www.pacerandicregistry.com). During the first year, they found three previously unreported device problems that were promptly communicated to the participants. Of the failures reported, 11% of ICD and 10% of pacemaker pulse generator failures were heralded by signs other than the expected elective replacement indicator (ERI). Average ICD battery longevity was 4.0 +/- 0.7 years, and average dual chamber pacemaker battery longevity was 6.8 +/- 2.6 years. Disrupted insulation accounted for 54% of pacemaker and 29% of ICD lead failures. Compared to pacemaker pulse generator and lead failure, ICD device failures were more likely to cause severe clinical consequences. In conclusion, an Internet-based registry is feasible and capable of providing timely data regarding the signs, causes, and clinical consequences of pacemaker and ICD failures.
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Affiliation(s)
- R Hauser
- Minneapolis Heart Institute Foundation, 920 E. 28th St., Ste #300, Minneapolis, MN 55407, USA.
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Abstract
We have recently cloned a novel protein (activity-dependent neuroprotective protein, ADNP) containing an 8-amino-acid, femtomolar-acting peptide, NAPVSIPQ (NAP). Here we show, for the first time, that NAP exerted a protective effect on glia-depleted neurons in culture. The number of surviving neurons was assessed in cerebral cortical cultures derived from newborn rats. In these cultures, a 24-h treatment with the beta-amyloid peptide (the Alzheimer's disease associated toxin) induced a 30-40% reduction in neuronal survival that was prevented by NAP (10(-13)-10(-11) M). Maximal survival was achieved at NAP concentrations of 10(-12) M. In a second set of experiments, a 5-day incubation period, with NAP added once (at the beginning of the incubation period) exhibited maximal protection at 10(-10) M NAP. In a third set of experiments, a 10-min period of glucose deprivation resulted in a 30-40% neuronal death that was prevented by a 24-h incubation with NAP. Glucose deprivation coupled with beta-amyloid treatment did not increase neuronal death, suggesting a common pathway. We thus conclude, that NAP can prevent neurotoxicity associated with direct action of the beta-amyloid peptide on neurons, perhaps through protection against impaired glucose metabolism.
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Affiliation(s)
- I Zemlyak
- Department of Clinical Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
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Love CJ, Wilkoff BL, Byrd CL, Belott PH, Brinker JA, Fearnot NE, Friedman RA, Furman S, Goode LB, Hayes DL, Kawanishi DT, Parsonnet V, Reiser C, Van Zandt HJ. Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 2000; 23:544-51. [PMID: 10793452 DOI: 10.1111/j.1540-8159.2000.tb00845.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The procedure of lead removal has recently matured into a definable, teachable art with its own specific tools and techniques. It is now time to recognize and formalize the practice of lead removal according to the current methods of medicine and the health care industry. In addition, since at this time the only prospective scientific study of lead extraction is the PLEXES trial, we suggest that studies relating to the techniques of and indications for lead extraction be designed. Recommendations for a common set of definitions, for a framework of training and reviewing physicians in the art, for general methods of reimbursement, and for consistency among clinical trials have been made. Implementation of these recommendations will require additional effort and cooperation from practicing physicians, medical societies, hospital administrations, and industry.
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Still J, Friedman B, Furman S, Cohen H, Gates C, Dawson J, Law E. Experience with the insertion of vena caval filters in acutely burned patients. Am Surg 2000; 66:277-9. [PMID: 10759199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The use of inferior vena caval filters in patients at high risk of pulmonary emboli is a standard practice in many types of patients. The usefulness of such filters in acutely burned patients has yet to be established. Twenty inferior vena caval filters were inserted in burn patients. Five were inserted because of preexisting thromboembolic disease. Fifteen were placed prophylactically because of high-risk states, including prolonged immobilization, old age, bleeding problems, and obesity. There were no complications due to filter insertion. No postinsertion emboli were recognized. There were no cases of postinsertion thrombophlebitis. In this small series, the procedure appears to be effective and safe.
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Affiliation(s)
- J Still
- Columbia-Augusta Medical Center Burn Unit, Georgia, USA
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Affiliation(s)
- I E Ovsyshcher
- Cardiology Division, Soroka Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Furman S, Sethi KK. Retraction statement. A new model of sustained atrial fibrillation in conscious dogs with pacing induced heart failure. Pacing Clin Electrophysiol 1998; 21:634. [PMID: 9616075 DOI: 10.1111/j.1540-8159.1998.tb00115.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Lead insulation material and implant route have a major impact on lead reliability and durability. We compare the incidence of lead insulation failure resulting from both the venous approach and insulation type. Two hundred ninety consecutive leads were followed for a mean period of 57 +/- 30 months; leads with < 1 year follow-up were excluded. There were 116 Silicone Rubber insulated leads and 174 with polyurethane (151 Pellethane 80A and 23 Pellethane 55D) insulation; 279 leads were bipolar and 11 unipolar; 274 leads were implanted in the ventricle and 66 in the atrium. The venous route was the subclavian vein for 170 leads (58%) and the cephalic vein for 120 leads (42%). Insulation failure was diagnosed when a single sign of oversensing, undersensing, failure to capture, early pulse battery depletion, and lead impedance < 250 omega was present. Measurement of lead impedance was performed intraoperatively at implantation and during lead revision or pulse generator replacement. Lead failure caused by conductor coil fracture was not considered. There were 13 lead insulation failures, all among leads with polyurethane insulation (12 Pellethane 80A and 1 Pellethane 55D). Eleven failures (10%) occurred when the subclavian vein and 2 (3%) when the cephalic vein approach was used. The cumulative survival rate of polyurethane and silicone rubber insulated leads was 88.7% and 100%, respectively (P = 0.02); the cumulative survival rate of polyurethane insulated leads was 83.2% when the subclavian vein and 95.1% when the cephalic vein were used (P = 0.03). The mean time to polyurethane lead failure when the subclavian vein approach was used was 54 +/- 17 months and when the cephalic route was 73 +/- 4 months (P < 0.02). By multivariate analysis, the route of entry was found to be a significant variable related to polyurethane insulated lead failure (P < 0.05). At lead revision failure to capture was present in 7, oversensing in 4, and undersensing in 2 instances; impedance was < 250 omega in all cases. Pellethane 80A insulated leads are prone to insulation failure, but more when the subclavian vein is used, rather than the cephalic vein.
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Affiliation(s)
- D Antonelli
- Department of Cardiology, Central Emek Hospital, Afula, Israel
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Kim SG, Sompalli V, Rameneni A, Gadde MK, Pamidi M, Pathapati R, Ferrick KJ, Gross J, Ben-Zur U, Furman S, Fisher JD. Symptomatic improvement after AV nodal ablation and pacemaker implantation for refractory atrial fibrillation and atrial flutter. Angiology 1997; 48:933-8. [PMID: 9373044 DOI: 10.1177/000331979704801101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Symptomatic Improvement was evaluated in 64 patients with drug-refractory atrial fibrillation or atrial flutter who underwent atrioventricular (AV) nodal ablation and permanent pacemaker implantation. The arrhythmias were chronic in 40 patients and paroxysmal in 24 patients. All were refractory to multiple drugs (3.7 +/- 1.5) and had severe symptoms: palpitations (58 patients), dyspnea (n=58), dizziness (n=38), asthenia (n=37), and chest pain (n=20). All underwent AV nodal ablation and single- (n=39) or dual-chamber (n=25) pacemaker implantation. During follow-up of 20.4 +/- 17.8 months, palpitations improved in 100% of 58 patients who had palpitations before the ablation, dyspnea improved in 75% of 58 patients, chest pain in 95% of 20 patients, asthenia in 75% of 37 patients, and dizziness in 93% of 38 patients. Moderate to significant improvement in these symptoms was reported in 83% of patients and mild improvement in 5%. Before ablation, 77% of patients were in New York Heart Association functional class III or IV. After ablation, 19% of patients were in the same functional classes (P < 0.05). Thus, AV nodal ablation and pacemaker implantation in patients with drug-refractory atrial fibrillation or flutter was associated with significant improvement in presenting symptoms and functional capacity. A randomized, controlled study is needed to compare this form of therapy with other therapeutic modalities.
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Affiliation(s)
- S G Kim
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467-2490, USA
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Abstract
Sodium-dependent phosphate entry into neuronal cells was demonstrated in synaptic plasma membrane vesicles and synaptosomes prepared from rat brains, in PC12 cells and in primary culture of pituitary cells. The extent of the sodium-dependent phosphate transport in the synaptic plasma membrane preparation, at [Na]out = 110 mM and [P(i)]out = 0.1 mM, varied between 0.28 to 1.02 nmol phosphate/mg membrane protein/min. In pituitary cells the value was only about 0.05 nmol P(i)/mg protein/min. In PC12 cells the activity increased from 0.0085 to 0.26 nmol P(i)/mg protein/min in the transit from undifferentiated to differentiated cells. The dependence of phosphate on sodium concentrations fits a model in which two sodium ions are required to transfer the phosphate into the cells with a K[Na]0.5 of 43 mM. The K(m) for the phosphate transport in the synaptic plasma membrane preparations was between 0.1 and 0.45 mM. It is concluded that sodium-driven active transport of phosphate is a ubiquitous activity in various types of neuronal cells.
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Affiliation(s)
- S Furman
- Department of Physiology, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Abstract
Transtelephone monitoring (TTM) is capable of detecting pacemaker pulse generator malfunction, battery depletion, and lead failure. The accuracy of TTM was analyzed by a review of Montefiore Medical Center records between October 1981 and March 1994. Each group of transmissions from a single patient, starting with implant and ending with a pacemaker operation, was defined as a closed cycle (CLOSE), if undergoing continuing follow-up at the time of analysis, as a continuing cycle (CONT), and if a cycle had ended with death or loss to follow-up, an open cycle (OPEN). TTM records of 2,632 patients were analyzed, providing 3,291 cycles. There were 731 CONT, 433 CLOSE, and 2,127 OPEN cycles; 331 procedures were indicated by TTM, of which 279 were impending depletion, 30 sudden depletion, and 22 lead malfunctions. Of the 102 procedures not indicated by TTM, 85 were for nonurgent reasons (recall: 41; DDD upgrade: 16; patient/MD request: 28) and 17 for urgent reasons. In patients followed by TTM who had a lead problem, 22 were detected by TTM before clinical manifestations and 16 were not. There were no cases in which TTM follow-up did not detect battery depletion. The total number of TTM contacts, available for 3,094 cycles, was 88,654 (range, 1-163, median 19), of which 0.4% yielded a procedure. During the same period, 75% of all secondary interventions during the first 2 years occurred during the first 2 months after implant because of lead malfunction, with a subsequent SI rate of 0.005 per month for the third through the twenty-fourth months.
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Affiliation(s)
- S Platt
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467-2409, USA
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Kim SG, Pathapati R, Fisher JD, Rameneni A, Nagabhairu R, Ferrick KJ, Roth JA, Ben-Zur U, Gross J, Brodman R, Furman S. Comparison of long-term outcomes of patients treated with nonthoracotomy and thoracotomy implantable defibrillators. Am J Cardiol 1996; 78:1109-12. [PMID: 8914872 DOI: 10.1016/s0002-9149(96)90061-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In 193 consecutive patients treated with implantable defibrillators at our institution, thoracotomy approaches were used in 87 patients and nonthoracotomy approaches in 106 patients. Long-term outcomes of the 2 groups were compared by the intention-to-treat analysis. Surgical mortality (30-day mortality) rates were 5.7% in the thoracotomy group and 0% in the nonthoracotomy group. Six of 106 patients who underwent nonthoracotomy implantation had a high defibrillation threshold and did not receive nonthoracotomy defibrillators. The duration of follow-up was 52 +/- 31 months in the thoracotomy group, and 23 +/- 15 months in nonthoracotomy group. Actuarial survival rates at 6 and 24 months were, respectively, 90% and 81% in nonthoracotomy patients and 89% and 80% in thoracotomy patients (p = NS). In patients with left ventricular ejection fraction <30%, surgical mortality was 0% by the nonthoracotomy and 10% by the thoracotomy approach. Despite the 10% difference in 30-day mortality, survival rates at 6 months were 85% in nonthoracotomy patients and 81% in thoracotomy patients. At 24 months they were 73% in nonthoracotomy patients and 74% in thoracotomy patients. Thus, this nonrandomized study suggests that while short-term survival is better in nonthoracotomy patients than thoracotomy patients, the difference in survival diminishes quickly during the first few months and disappears by 6 months. The results were similar in patients with severe ventricular dysfunction. Several important implantable-cardioverter defibrillator (ICD) trials initially utilized thoracotomy ICDs. Although questions may be raised with regard to applicability of such a trial in the era of nonthoracotomy ICDs, this study suggests that the results of such ICD trials will be largely applicable to patients treated with nonthoracotomy ICDs.
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Affiliation(s)
- S G Kim
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Palma EC, Kedarnath V, Vankawalla V, Andrews CA, Hanson S, Furman S, Gross JN. Effect of varying atrial sensitivity, AV interval, and detection algorithm on automatic mode switching. Pacing Clin Electrophysiol 1996; 19:1735-9. [PMID: 9045215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Automatic mode switching (AMS) is absolutely dependent on atrial tachyarrhythmia detection. The effects of programming several features that could influence tachyarrhythmia detection were assessed in 18 patients (six women; mean age 64 years) with pacemakers having AMS capability. The atrial electrogram amplitude in sinus rhythm at implant (SR-EGM), last measured atrial sensing threshold prior to tachycardia (A-SENS), and atrial sensing threshold for effective AMS during atrial tachyarrhythmia (AMS-SENS) were obtained. Additionally, ten patients had AV intervals increased from 60 to 200 ms, while seven patients had detection algorithms made more stringent from 5 beats at 150 beats/min to 11 beats at 200 beats/min to assess their effects on AMS efficacy. RESULTS Sensitivities:Mean SR-EGM = 3.55 mV; mean A-SENS = 2.06 mV; and mean AMS-SENS = 1.46 mV. Fourteen patients developed atrial fibrillation and four atrial flutter. Thirteen of 14 patients who developed atrial fibrillation sensed adequately at > or = 1.0 mV in normal sinus rhythm (NSR), but only six patients had effective AMS at these settings in atrial fibrillation. Three of four patients who developed atrial flutter had effective AMS at > or = 2.0 mV. AV Interval:AMS was effective in eight of ten patients at AV intervals up to 200 ms. One patient lost AMS at an AV interval of 120 ms. Algorithm: In two of seven patients, AMS was not effective if the detection algorithm was more stringent than five beats at 150 beats/min. CONCLUSIONS (1) In atrial fibrillation, effective AMS requires more sensitive atrial settings than in NSR; (2) AV intervals as short as 120 ms can interfere with AMS function; and (3) More stringent detection algorithms may be inappropriate for effective AMS function.
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Affiliation(s)
- E C Palma
- Pacemaker Center, Montefiore Medical Center, Bronx, New York 10467, USA
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31
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Kawanishi DT, Song S, Furman S, Parsonnet V, Pioger G, Petitot JC, Godin JF. Failure rates of leads, pulse generators, and programmers have not diminished over the last 20 years: formal monitoring of performance is still needed. BILITCH Registry and STIMAREC. Pacing Clin Electrophysiol 1996; 19:1819-23. [PMID: 8945048 DOI: 10.1111/j.1540-8159.1996.tb03232.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Formal Monitoring of Performance is Still Needed. In order to detect trends in the number of device or component failures that have occurred among permanent pacemaker systems since the 1970s, we reviewed the data of the five largest pacemaker manufacturers from the Bilitch Registry of permanent pacemaker pulse generators, the Stimarec failure registry, the general accounting office summaries of the United States Veterans Administration (VA) Registry of Pacemaker Leads, and the Implantable Lead Registry, from the Cleveland Clinic Lead registry, and the recalls and safety alerts issued by the United States Food and Drug Administration (FDA) over the last 20 years. The definition of failure followed the criterion, or criteria, developed within each registry and differed significantly between the registries. The 20-year period between 1976 and 1995 was divided into 5-year quartiles (QT): QT 1 = 1976-1980; QT2 = 1981-1985; QT3 = 1986-1990; and QT4 = 1991-1995. For pulse generators, the number of models with failures in each quartile in the Bilitch Registry were: QT 1 = 9; QT 2 = 11; QT3 = 17; QT4 = 13. In Stimarec, the number of units reported as having reached a dangerous condition were: QT1 = 710; QT2 = 212; QT3 = 114; QT4 = 310. From the FDA reports, the number of units included in recalls or safety alerts were: QT3 = 6,085; QT4 = 135,766. For permanent pacemaker leads, the numbers of failed or dangerous leads recorded in Stimarec were: QT3 = 16; QT4 = 32. In the VA Registry, the number of models having a below average survival was 2/92 (2.7%). In the Implantable Lead Registry, the number of models having a below average survival was 3/21 (14%). In the Cleveland Clinic series, 6/13 (46%) of lead models were recognized to have some failure involving the conductor, insulation, or connector. In the FDA reports, the number of leads involved in either recall or safety alert were: QT3 = 20,354; QT4 = 332,105. For programmers, the number of units involved either in a recall or safety alert were: QT3 = 11,124; QT4 = 3,528. In all of these series, each of the five largest manufacturers had some models or units involved in each time period. This review of programs has revealed: 1. The incidence of failures, recalls, or safety alerts did not decline over time; and 2. Despite changes in technology, formal monitoring of pacemaker systems is still warranted.
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Affiliation(s)
- D T Kawanishi
- University of Southern California Pacemaker Center, Los Angeles 221-4428, USA
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Gallik DM, Ben-Zur UM, Gross JN, Furman S. Lead fracture in cephalic versus subclavian approach with transvenous implantable cardioverter defibrillator systems. Pacing Clin Electrophysiol 1996; 19:1089-94. [PMID: 8823837 DOI: 10.1111/j.1540-8159.1996.tb03418.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Lead fracture, occurring in approximately 1%-4% of patients, is an infrequent, but potentially catastrophic complication of permanent pacing systems. Its incidence in transvenous defibrillator systems has not been established. We analyzed data from 757 patients undergoing implantation of transvenous cardioverter defibrillator systems using the Medtronic Transvene Lead system between October 20, 1989 and June 25, 1992 to determine if site of venous approach influenced incidence of lead fracture. All patients received a 3-lead system in 1 of 3 configurations: (1) right ventricle/superior vena cava/subcutaneous patch; (2) right ventricle/coronary sinus/subcutaneous patch; or (3) right ventricle/superior vena cava/coronary sinus. Of 767 right ventricular leads placed, 523 were placed via the subclavian vein, 221 via cephalic vein, and 18 via the internal jugular (5 leads were implanted using another vein). The total number of leads is greater than the total number of patients, as five patients received a second defibrillator system if the initial system was explanted and reimplanted for any reason. Seven patients (0.9%) had right ventricular lead fracture, presenting with inappropriate defibrillator shocks (1), loss of pacing ability (3), both loss of pacing ability and inappropriate shocks (1), or increased pacing threshold (2). All patients required reoperation. All had leads placed by the subclavian venous approach, with chest X ray confirming fracture at the clavicle-first rib junction in 6 of 7 cases. Using Fisher's Exact test, the difference in lead fracture between subclavian and cephalic vein implant approached statistical significance (P = 0.08). The trend toward increased lead fracture incidence with leads placed via subclavian vein suggests that cephalic vein approach may be preferable to avoid this complication.
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Affiliation(s)
- D M Gallik
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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33
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Volmink J, Laubscher J, Furman S. The SASPREN primary care survey -- who consults the family doctor? S Afr Med J 1996; 86:241-5. [PMID: 8658293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To describe selected characteristics of patients consulting general/family practitioners in the Western Cape. DESIGN A cross-sectional survey design was employed in which doctors completed a structured questionnaire during or immediately after each consultation. SETTING Data were collected by family practitioners in private practice who were affiliated to the South African Sentinel Practitioner Research Network (SASPREN). PARTICIPANTS All patients who had a face-to-face encounter with the doctor at his/her surgery. A total of 2 473 such encounters was included. MAIN OUTCOME MEASURES Age, sex, race, method of payment and smoking status. RESULTS Females outnumbered males in all race groups except blacks, where they comprised 48% of patients. Most patients were under the age of 14 years (23.3%) or between 25 and 44 years (33.3%). However, after the demography of the catchment population was taken into account, the highest utilisation of general practitioner services was found to be at extremes of age. This utilisation pattern was demonstrated in both sexes and all races. In relation to their distribution in the population, whites and Indians are over-represented in private practice while blacks and coloureds are under-represented. The bulk of patients (67%) pay for general practitioner services via some form of insurance (medical aid or benefit fund), but significant differences exist across race groups. In the case of blacks and Indians, the majority (72% and 64% respectively) of consultations are funded 'out of pocket'. An alarmingly high smoking prevalence was found in black and coloured men. In all race/sex groups smoking rates peak between 25 and 44 years. In this age group, 68.6% of black men and 73.3% of coloured men were current smokers. CONCLUSIONS This study provides essential information on patients seen in family practice. Access to family doctor services in the Western Cape should be improved for blacks and coloureds. There is an urgent need for smoking cessation interventions in the region.
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Affiliation(s)
- J Volmink
- Centre for Epidemiological Research in Southern Africa, Medical Research Council, Tygerberg, W. Cape
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35
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Malik M, Mercando A, Furman S. PACE and advances in computing and electronic technology. Pacing Clin Electrophysiol 1996; 19:107-8. [PMID: 8848365 DOI: 10.1111/j.1540-8159.1996.tb04797.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ben-Zur UM, Kahn S, Gross JN, Platt SB, Goodfriend MA, Furman S. Suppression of ventricular output by noise in the atrial channel in a dual chamber pacemaker. Pacing Clin Electrophysiol 1995; 18:1586-8. [PMID: 7479181 DOI: 10.1111/j.1540-8159.1995.tb06746.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In a pacemaker dependent, 60-year-old man with complete heart block, programming high (5.0 V and 1.0 ms) atrial output and 5.0 volt and 0.5 ms ventricular output while in the DDD mode of a pulse generator, resulted in loss of ventricular channel output with resulting asystole, while the simultaneous, pulse generator produced ECG interpretation channel falsely indicated continuing ventricular channel output. Ventricular pacing was promptly restored by programming to the emergency VVI mode. At later operation the atrial lead was determined to be defective, with a low impedance, while the ventricular lead was intact (lead impedance telemetry was not available). The manufacturer has acknowledged a pulse generator design anomaly that may occur in the setting of a low atrial impedance and issued a Health Safety Alert.
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Affiliation(s)
- U M Ben-Zur
- Montefiore Medical Center, Division of Cardiology, Bronx, NY 10467, USA
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37
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Kim SG, Roth JA, Fisher JD, Chung J, Nagabhairu R, Ferrick KJ, Ben-Zur U, Gross J, Furman S. Long-term outcomes and modes of death of patients treated with nonthoracotomy implantable defibrillators. Am J Cardiol 1995; 75:1229-32. [PMID: 7778545 DOI: 10.1016/s0002-9149(99)80768-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Long-term outcomes of all patients who underwent nonthoracotomy implantable cardioverter-defibrillator (ICD) implantation at our institution from April 1991 to October 1994 were studied using the intention-to-treat analysis. Of 94 consecutive patients, 81 underwent nonthoracotomy ICD implantation and 13 underwent thoracotomy (for concomitant surgery in 11 and unavailability of nonthoracotomy leads in 2). Six of 81 patients had a high defibrillation threshold, 4 subsequently underwent thoracotomy, and 2 were treated with amiodarone. Surgical mortality was 0%. The duration of follow-up was 20 +/- 13 months, and was > 12 months in 74% of 67 living patients. Actuarial survival rates at 1 and 2 years were, respectively, 98% and 94% for sudden death and 91% and 83% for total mortality. Deaths during long-term follow-up were mostly due to nonsudden cardiac or noncardiac deaths. Two-year mortality rates were 12% and 25% in patients with ejection fraction > or = 30% and < 30%, respectively. Thus, instances of sudden death and surgical mortality are very few in patients with nonthoracotomy ICDs. Deaths during long-term follow-up are mostly due to nonsudden cardiac and noncardiac deaths. Therefore, ICD therapy may have greater impact on survival in patients with lower risks of nonsudden cardiac and cardiac death (e.g., younger patients with minimal heart disease) than in patients with severe cardiac or noncardiac disease. Prospective studies are needed to address this question.
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Affiliation(s)
- S G Kim
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467-2490, USA
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38
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Ovsyshcher I, Furman S. Importance of an individually programmed atrioventricular delay at rest and on work capacity in patients with dual chamber pacemakers. Pacing Clin Electrophysiol 1995; 18:751-2. [PMID: 7596865 DOI: 10.1111/j.1540-8159.1995.tb04680.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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40
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Abstract
The functional details of all 5,405 pacemaker leads implanted on Montefiore Medical Center were contemporaneously recorded between 1960 and May 31, 1993. Some models have been observed for as long as 24 years. Ventricular leads with more than 50 and atrial leads with more than 30 implanted units have been continually and repeatedly subjected to actuarial cumulative survival rate (CSR) analysis during which clinical decisions, such as continued lead implantation, cessation of use, or early withdrawal from service, were made. CSR evaluation for many lead models by the Mantel-Haenszel method allowed comparison of the performance of contemporaneous lead models with older and new technologies. No effect on lead longevity, durability, on mode of end of lead service, lead removal independent of function (e.g., for infection), materials, or physiological failure was found due to an operator or anatomical route of venous access. Multifilar silicone rubber insulated leads have longevity (CSR) superior to monofilar silicone rubber leads. The cumulative survival of silicone rubber insulated monofilar models 6901, 6907, continuous lead (CL), 4 mm, and 2 mm was 79%-91%, 20 years after implantation. Multifilar silicone rubber insulated models 6961 and 4116 had a cumulative survival of 99%-100%, 15 years after implantation. Among multifilar polyurethane insulated leads, distinct longevity differences exist between formulations and contemporaneous models that are normally similar, yielding a bimodal longevity distinction; model 6971 (ventricular) has 95% CSR and 6991U (atrial) has 94% CSR, 10 years after implantation. Both performed less well than other contemporaneous models, which approximate 100% CSR. The 10-year CSR for leads implanted between 1960-1975 (Era 1) is 98.7%, and the 10-year CSR of leads implanted between 1981-1985 (Era 3) is 99.4%. Comparison of individual lead models, and all leads of specific eras, allows development of survival expectations and standards of quality for comparison between contemporaneous lead models and different eras of manufacture. As the highest available lead CSR sets the standard, statistical deviation of a model from the best performance of a specific era should be considered as an indication of reduced quality.
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Affiliation(s)
- S Furman
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York
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Abstract
OBJECTIVES We undertook this study to determine whether telemetered lead impedance measurements (LIM) can be correlated with direct LIM and to determine the stability of LIM over time when measured directly and via telemetry. METHODS Direct LIM and telemetered LIM were measured in 91 patients; 101 leads during initial implantation and 40 leads during pulse generator replacement. Differences in direct LIM measured during initial implant and pulse generator replacement (direct-direct) were compared in 41 patients (28 atrial leads and 37 ventricular leads). The stability of telemetered LIM obtained immediately postoperatively, at 1 month and 1 year, postimplantation was assessed in 50 patients (23 atrial and 49 ventricular leads). RESULTS In atrial leads acute direct LIM was 633.9 +/- 18.4 omega versus 575.8 +/- 18.5 omega for telemetered LIM (r = 0.58), and chronic direct LIM was 670.9 +/- 49.3 omega versus 607.0 +/- 36.3 omega for telemetered LIM (r = 0.87). In ventricular leads acute direct LIM was 747.3 +/- 16.9 omega and 684.7 +/- 16.4 omega for telemetered LIM (r = 0.69), and chronic direct LIM was 674.8 +/- 29.9 omega and 625.2 +/- 28.5 omega for telemetered LIM (r = 0.68). The mean direct-direct LIM rose 124 omega (P < 0.001) in atrial leads and 10 omega (P = NS) in ventricular leads. Telemetered LIM for atrial leads was 581.0 +/- 27.6 omega immediately postimplantation compared to 625.7 +/- 34.8 omega at 1 month and 754.1 +/- 43.0 omega at 1 year. Telemetered LIM for ventricular leads was 661.3 +/- 17.5 omega at implant, 684.6 +/- 20.7 omega at 1 month and 724.7 +/- 22.7 omega at 1 year. CONCLUSIONS There is a good but limited correlation between direct and telemetered LIM. Mean direct LIM obtained at initial implantation is similar to that measured at pulse generator replacement. The telemetered LIM is stable over the first month postimplantation but tends to rise during the first year of follow-up and substantial changes in impedance are not uncommon in individuals with normal function. There is a tendency for LIM to rise with lead maturation. If telemetered LIM is to be followed over time, a baseline telemetered value should be obtained immediately postoperatively.
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Affiliation(s)
- U M Ben-Zur
- Department of Medicine, Montefiore Medical Center, Bronx, New York
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43
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Affiliation(s)
- S Furman
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York 10467
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44
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Ben-Zur UM, Gross JN, Goldberger MH, Tilkemeier PL, Weyman AK, Furman S. Oversensing of pacemakers in the bipolar pacing configuration: paradoxic resolution with programming to unipolar sensing. Am Heart J 1994; 128:617-9. [PMID: 8074029 DOI: 10.1016/0002-8703(94)90641-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- U M Ben-Zur
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467
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Choue CW, Kim SG, Fisher JD, Roth JA, Ferrick KJ, Brodman R, Frame R, Gross J, Furman S. Comparison of defibrillator therapy and other therapeutic modalities for sustained ventricular tachycardia or ventricular fibrillation associated with coronary artery disease. Am J Cardiol 1994; 73:1075-9. [PMID: 8198033 DOI: 10.1016/0002-9149(94)90286-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Outcomes of 282 patients referred to the arrhythmia service at Montefiore Medical Center for sustained ventricular tachycardia (n = 214) or ventricular fibrillation (n = 68) associated with coronary artery disease were analyzed retrospectively. All patients underwent serial drug trials by electrophysiologic testing and Holter monitoring. Sixty-eight patients who did not respond to drug therapy were treated with implantable cardioverter-defibrillators (ICD group), and 214 patients were treated with other methods guided by electrophysiologic testing and Holter monitoring (non-ICD group). The non-ICD group included 49 patients who responded to drug therapy as judged by electrophysiologic testing, as well as patients who did not respond and were not treated with defibrillator therapy for various reasons. Ten patients died in the hospital (2 patients in the ICD group, 8 in the non-ICD group). Actuarial survival rates free of total cardiac death at 1, 2, and 3 years were, respectively, 94%, 87%, and 85% in the ICD group, and 82%, 78%, and 73% in the non-ICD group (p = NS). Survival rates free of total death at 1, 2, and 3 years were 90%, 82%, and 76% in the ICD group, and 82%, 76%, and 70% in the non-ICD group, respectively (p = NS). Survival rates free of total cardiac and total deaths of 49 patients treated with an effective regimen determined by electrophysiologic testing were not significantly different from those of the ICD group. This retrospective study suggests that outcomes of patients treated with ICDs may not be dramatically different from those of patients treated with other methods guided primarily by electrophysiologic testing.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C W Choue
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York 10467
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Brodman RF, Furman S, Fell SC, Foxx MJ, Frame RA, Fisher JD, Kim SG, Roth JA, Ferrick KJ. ICD implantation via thoracoscopy, "mailslot" thoracotomy, and subxiphoid incision. Ann Thorac Surg 1994; 57:475-6. [PMID: 8311618 DOI: 10.1016/0003-4975(94)91023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An improved method of thoracoscopic implantable cardioverter defibrillators implantation is described. "Mailslot" thoracotomy is more expeditious than thoracoscopic implantation via multiple ports. If required for adequate defibrillation thresholds, subxiphoid, subdiaphragmatic implantation of a defibrillator patch may be performed.
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Affiliation(s)
- R F Brodman
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, NY 10467
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48
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49
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Hayes DL, Naccarelli GV, Furman S, Parsonnet V. Report of the NASPE Policy Conference training requirements for permanent pacemaker selection, implantation, and follow-up. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol 1994; 17:6-12. [PMID: 7511233 DOI: 10.1111/j.1540-8159.1994.tb01343.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
NASPE proposes and supports the concept of a two-tracked training system in cardiac pacing. Track I training will properly train physicians for the prescription of pacemakers and the monitoring of pacemaker patients, and track II training will properly prepare physicians for the implantation of pacemakers. Regardless of specialty (cardiologist or surgeon) or training venue (cardiac pacing fellowship, cardiac electrophysiology and pacing fellowship, sabbatical or mentor sponsored training), it is recommended that these minimum standards be required for hospital credentialing. NASPE also supports the voluntary institution by training program directors of core pacing training in cardiovascular disease and cardiac electrophysiology fellowships. This core training does not in itself constitute proper track I or II training for physicians interested in adequately prescribing, monitoring, or implanting cardiac pacemakers.
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Affiliation(s)
- D L Hayes
- North American Society of Pacing and Electrophysiology, Newton Upper Falls, Massachusetts 02164
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Furman S, Berkowicz L, Dippenaar J, Hellenberg DA, Montanus MS, Steinberg A, Schall R. Cefetamet pivoxil vs cefaclor in the treatment of acute otitis media in children. Drugs 1994; 47 Suppl 3:21-6. [PMID: 7518763 DOI: 10.2165/00003495-199400473-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
74 children with acute otitis media (AOM) were entered into an observer-blind randomised multicentre general practice study to compare the efficacy and safety of the new third generation oral cephalosporin, cefetamet pivoxil, at a dose of 10 mg/kg twice daily with the efficacy and safety of cefaclor 10 mg/kg twice daily administered for 10 days. Of 36 evaluable patients in the cefaclor treatment group, 28 (78%) were cured, and a further 4 were improved, giving an overall efficacy rate (cure/improvement) of 89%. Of 36 evaluable patients in the cefetamet pivoxil treatment group, 31 (86%) were cured, and a further 4 were improved, giving an overall efficacy rate of 97%. Adverse events were reported in 4 patients: 1 cefaclor recipient and 3 patients in the cefetamet pivoxil treatment group. Diarrhoea, the most frequently observed adverse event, occurred in both treatment groups. The study results indicate that cefetamet pivoxil and cefaclor appear to have similar efficacy and safety in the treatment of AOM in children.
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Affiliation(s)
- S Furman
- Academy of Family Practice/Primary Care, Cape Town, South Africa
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