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Development and guidance of dosing schemes in children have been supported by physiology‐based pharmacokinetic (PBPK) modeling for many years. PBPK models are built on a generic basis, where compound‐ and system‐specific parameters are separated and can be exchanged, allowing the translation of these models from adults to children by accounting for physiological differences. Owing to these features, PBPK modeling is a valuable approach to support clinical decision making for dosing in children. In this analysis, we evaluate pediatric PBPK models for 10 small‐molecule compounds that were applied to support clinical decision processes at Bayer for their predictive power in different age groups. Ratios of PBPK‐predicted to observed PK parameters for the evaluated drugs in different pediatric age groups were estimated. Predictive performance was analyzed on the basis of a 2‐fold error range and the bioequivalence range (ie, 0.8 ≤ predicted/observed ≤ 1.25). For all 10 compounds, all predicted‐to‐observed PK ratios were within a 2‐fold error range (n = 27), with two‐thirds of the ratios within the bioequivalence range (n = 18). The findings demonstrate that the pharmacokinetics of these compounds was successfully and adequately predicted in different pediatric age groups. This illustrates the applicability of PBPK for guiding dosing schemes in the pediatric population. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite optimal drug and device therapy, frequent hospitalisations due to decompensated heart failure remain an issue. Early detection of decompensation could prevent hospitalisation in patients with congestive heart failure. The recently introduced Home Monitoring functionality of implanted devices is a promising new telecardiology technique which provides information on the status of heart failure. Home Monitoring observation of heart failure patients could lead to early detection of preclinical decompensation, enable early intervention before clinical decompensation, and thus could prevent hospitalisations. Objective: The IN-TIME study is designed to assess the impact of Home Monitoring on the early detection of worsening congestive heart failure and the clinical status of heart failure patients. Study design: Approximately 620 patients will be prospectively randomised to patient management guided by Home Monitoring analysis or standard care and followed for 12 months. The endpoints committee will adjudicate events in a blinded fashion. The primary endpoint is a composite of all-cause mortality, unplanned hospitalisation due to worsening heart failure, NYHA class and patient global self assessment (Packer score). The study should complete recruitment during 2009 and report in late 2010. [Copyright &y& Elsevier]

The anterior single-implant restoration provides a predictable solution for the partially edentulous patient. The two main approaches in prosthesis design for the single-implant restoration are the screw-retained and cement-retained restorations. Although both approaches have been proven to work from a standpoint of long-term implant stability, other considerations arise when esthetic outcome and ease of fabrication and delivery are discussed. To guarantee a predictable outcome, the dentist should choose a design that offers maximum prosthetic versatility. Combining prosthetic versatility with ease of delivery is often a clinical and laboratory challenge. Prostheses designs that provide the freedom to select a wide variety of restorative materials may be cumbersome to deliver and maintain and vice versa. This article reviews the advantages and shortcomings of each design and provides an alternative prosthesis design that combines the favorable aspects of these two restorations. CLINICAL SIGNIFICANCE Screw-retained and cement-retained prostheses are the common designs for single-implant restorations and possess clinical advantages and shortcomings. An alternative and affordable design, that is mainly beneficial when standard stock implants components are used, is presented. It enables the clinician to achieve optimal esthetics in the esthetic zone combined with a simple and time-efficient delivery. [ABSTRACT FROM AUTHOR]

GRADAUS, R., et al.: Mortality, Morbidity, and Complications in 3,344 Patients with Implantable Cardioverter Defibrillators: Results From the German ICD Registry EURID. --> ICDs are the therapy of choice in patients with life‐threatening ventricular arrhythmias. Mortality, morbidity, and complication rates including appropriate and inappropriate therapies are unknown when ICDs are used in routine medical care and not in well‐defined patients included in multicenter trials. Therefore, the data of 3,344 patients (61.1 ± 12.1  years; 80.2% men; CAD 64.6%, dilated cardiomyopathy 18.9%; NYHA Class I–III: 19.1%, 54.3%, 20.1%, respectively;LVEF > 0.50: 0.234, LVEF 0.30–0.50: 0.472,LVEF < 0.30: 0.293, respectively) implanted in 62 German hospitals between January 1998 and October 2000 were prospectively collected and analyzed as a part of the European Registry of Implantable Defibrillators (EURID Germany). The 1‐year survival rate was 93.5%. Patients in NYHA Class III and aLVEF < 0.30had a lower survival rate than patients in NYHA Class I and a preserved LVEF (0.852 vs 0.975,P = 0.0001). Including the 1‐year follow‐up, 49.5% of patients had an intervention by the ICD, 39.8% had appropriate ICD therapies, 16.2% had inappropriate therapies. Overall, 1,691 hospital readmissions were recorded. The main causes for hospital readmissions were ventricular arrhythmias (61.3%) and congestive heart failure symptoms (12.9%). Thus, demographic data and mortality of patients treated with an ICD in conditions of standard medical care seems to be comparable and based on, or congruent with, the large secondary preventions trials. When ICDs are used in standard medical care, the 1‐year survival rate is high, especially in patients with NYHA Class I and preserved LVEF. However, nearly half of all patients suffer from ICD intervention. (PACE 2003; 26[Pt. I]:1511–1518) [ABSTRACT FROM AUTHOR]

Introduction: Placement of implantable cardioverter defibrillators (ICDs) has been simplified by using the shell of a pectorally implanted ICD as a defibrillation electrode in combination with an endocardial right ventricular defibrillation lead. However, a sufficiently low defibrillation threshold (DFT) cannot be obtained in a few patients. Therefore, alternative approaches were systematically tested in the Active Can versus Array Trial (ACAT). Methods and Results: In the first of two prospective randomized studies, the DFT of a subcutaneous left dorsolateral array anode introduced from a pectoral incision was compared to that of a standard active can anode in 68 patients. Intraoperatively, the DFT was determined twice in each patient using either the active can or, in patients with a subcutaneous array lead, once with all three fingers and once omitting the middle finger of the array. The second prospective randomized study included 40 patients. DFT also was determined twice in each patient using an active can in a left pectoral position as anode alone and combined with a left dorsolateral array electrode with two fingers. In ACAT I, stored energy at DFT decreased from 13.1 ± 7.7 J (active can) to 9.6 ± 6.1 J (three-finger array lead) (P = 0.04), impedance decreased from 53 ± 8 Ω to 40 ± 6 Ω (P < 0.0001). Omitting the middle finger of the array lead, stored energy at DFT increased by 0.9 J (P = 0.47) and impedance by 2 Ω (P < 0.0001). In ACAT II, DFT and impedance using an active can device were significantly lower when a two-finger array lead was added that decreased stored energy at DFT from 10.1 ± 5.2 J to 6.9 ± 3.9 J (P = 0.001) and impedance from 56 ± 5 Ω to 42 ± 5 Ω (P < 0.0001). Conclusion: In combination with a right ventricular defibrillation electrode, a left pectoral subcutaneous array lead improves defibrillation efficacy if used instead of, or in addition to, a left pectoral active can ICD device. Implantation of the array lead can be simplified by using two instead of three fingers, without a significant loss of defibrillation efficacy. [ABSTRACT FROM AUTHOR]

Dual-chamber ICDs are increasingly used to avoid inappropriate shocks due to supraventricular tachycardias. Additionally, many ICD patients will probably benefit from dual chamber pacing. The purpose of this pilot study was to evaluate the intraoperative performance and short-term follow-up of an innovative single pass right ventricular defibrillation lead capable of bipolar sensing and pacing in the right atrium and ventricle. Implantation of this single pass right ventricular defibrillation lead was successful in all 13 patients (age 63 ± 8 years; LVEF 0.44 ± 0.16; New York Heart Association [NYHA] 2.4 ± 0.4, previous open heart surgery in all patients). The operation time was 79 ± 29 minutes, the fluoroscopy time 4.7 ± 3.1 minutes. No perioperative complications occurred. The intraoperative atrial sensing was 1.7 ± 0.5 mV, the atrial pacing threshold product was 0.20 ± 0.14 V/ms (range 0.03-0.50 V/ms). The defibrillation threshold was 8.8 ± 2.7 J. At prehospital discharge and at 1-month and 3-month follow-up, atrial sensing was 1.9 ± 0.9, 2.1 ± 0.5, and 2.7 ± 0.6 mV, respectively, (P = NS, P < 0.05, P < 0.05 to implant, respectively), the mean atrial threshold product 0.79, 1.65, and 1.29 V/ms, respectively. In two patients, an intermittent exit block occurred in different body postures. All spontaneous and induced ventricular arrhythmias were detected and terminated appropriately. Thus, in a highly selected patient group, atrial and ventricular sensing and pacing with a single lead is possible under consideration of an atrial pacing dysfunction in 17% of patients. [ABSTRACT FROM AUTHOR]

Introduction: Inappropriate therapies are the most frequent adverse event in patients with implantable cardioverter defibrillators (ICDs). Most ICDs offer a stability criterion to discriminate ventricular tachycardia (VT) from atrial fibrillation and an onset criterion to discriminate VT from sinus tachycardia. The efficacy and safety of these criteria, if used immediately after implantation, is unknown. Methods and Results: In a case control study, 87 patients in whom stability and onset criteria had been activated immediately after ICD implantation were matched to 87 patients in whom these criteria had not been activated. The groups were matched for known predictors of inappropriate therapies. With stability and onset criteria off, 24 patients (28%) received inappropriate therapies due to atrial fibrillation (n = 14) or sinus tachycardia (n = 11); with stability and onset on, only 11 patients (13%) were treated by the lCD due to atrial fibrillation (n = 5) or sinus tachycardia (n = 7) (log rank: P = 0.029), Five patients suffered Inappropriate therapies despite the fact that onset (n = 4) or stability (n = 1) criteria were not fulfilled once tachycardias continued for a prespecified duration. Only one patient experienced a failure to detect VT due to the onset criterion; none because of stability. Conclusion: The immediate use of stability and onset criteria after lCD Implantation reduces inappropriate therapies due to atrial fibrillation and sinus tachycardia. Because of the potential for underdetection of VT, this approach should be limited to tachycardia rates hemodynamically tolerated by the patient. [ABSTRACT FROM AUTHOR]

The Sentencing Reform Act of 1984, which created the U.S. Sentencing Commission, required that the commission consider prison capacity in drafting sentencing guidelines. As part of the commission's efforts to meet this requirement, we developed a computer simulation capable of projecting the impact of the commission's guidelines on future sentences and prison populations. According to our projections, "straight" probation sentences will be reduced significantly under the guidelines. However, reducing the use of probation will generate only modest demands on the prisons, and then mostly for community corrections phased in over the course of S years. We also project that, while average time served for violent offenses will increase substantially, average time served for most property crimes will remain largely the same. Finally, while we forecast that federal prison populations will grow markedly by the end of this century, this is more a result of the Anti- Drug Abuse Act of 1986 and the career offender provision of the Comprehensive Crime Control Act of 1984 than a result of the guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Perioperative mortality of patients undergoing implantation of automatic implantable cardioverter defibrillators (ICDs) has been reduced dramatically following the availibility of transvenous-subcutaneous defibrillation leads. However, patients with severely reduced left ventricular function show a substantial rate of nonsudden cardiac mortality within the first year. Whether repeated intraoperative inductions of ventricular tachycardia/fibrillation (VT/VF) during implantation lead to hemodynamic deterioration and thus might contribute to development of end-stage heart failure in these patients is unknown. The purpose of the present study was to determine cardiac output and hemodynamic performance during transvenous-subcutaneous ICD implantation in patients with severe left ventricular dysfunction. Methods and Results: In 11 patients with a left ventricular ejection fraction (EF) ≤ 0.35, cardiac output was measured automatically with a combined continuous cardiac output/mixed venous oxygen saturation pulmonary artery catheter system. ICD implantation was performed during standardized general anesthesia, in the 11 patients (EF = 27 ± 2% [mean ± SEM]) a total of 95 episodes of VT/VF followed by defibrillation were induced (epsiodes per patient = 9 ± 1; range 6 to 11). Cardiac index was 2.2 ± 0.2 L·min-1·m-2 after induction of anesthesia (before start of surgery), and 1.9 ± 0.1 L·min-1·m-2 immediately before first induction of VT/VF, After the last episode of VT/VF, cardiac index was 2.1 ± 0.2 L·min-1·m-2. Cardiac index measured 1, 2, and 3 minutes after induction of VT/VF was not significantly different when compared to the preinduction value during any episode of VT/VF induction. Similarly, stroke volume index was 39 ± 5 mL·m-2 immediately before first induction of VT/VF and 36 ± 3 mL·m-2 after the last episode of VT/VF (NS). At the end of surgery, hemodynamic parameters did not exhibit any significant difference when compared to the data obtained before start of ICD implantation and testing. Conclusion: Extensive defibrillation tests during transvenous-subcutaneous ICD implantation in patients with severe left ventricular dysfunction are not associated with acute deterioration of cardiac performance. [ABSTRACT FROM AUTHOR]

Introduction: The size of current implantable cardioverter defibrillators (ICD) is still large in comparison to pacemakers and thus not convenient for pectoral implantation. One way to reduce ICD size is to defibrillate with smaller capacitors. A trade-off exists, however, since smaller capacitors may generate a lower maximum energy output. Methods and Results: In a prospective randomized cross-over study, the step-down defibrillation threshold (DFT) of an experimental 90-μF biphasic waveform was compared to a standard 125-μF biphasic waveform. The 90-μF capacitor delivered the same energy faster and with a higher peak voltage but provided only a maximum energy output of 20 instead of 34 J. DFTs were determined intraoperatively in 30 patients randomized to receive either an endocardial (n = 15) or an endocardial-subcutaneous array (n = 15) defibrillation lead system. Independent of the lead system used, energy requirements did not differ at DFT for the experimental and the standard waveforms (10.3 ± 4.1 and 9.5 ± 4.9 J, respectively), but peak voltages were higher for the experimental waveform than for the standard waveform (411 ± 80 and 325 ± 81 V, respectively). For the experimental waveform the DFT was 10 J or less using an endocardial lead-alone system in 10 (67%) of 15 patients and in 12 (80%) of 15 patients using an endocardial-subcutaneous array lead system. Conclusions: A shorter duration waveform delivered by smaller capacitors does not increase defibrillation energy requirements and might reduce device size. However, the smaller capacitance reduces the maximum energy output. If a 10-J safety margin between DFT and maximum energy output of the ICD is required, only a subgroup of patients will benefit from 90-μF ICDs with DFTs feasible using current defibrillation lead systems. [ABSTRACT FROM AUTHOR]

Introduction: The defibrillation threshold (DFT) of a transvenous-subcutaneous electrode configuration is sometimes unacceptably high. To obtain a DFT with a sufficient safety margin, the defibrillation field can he modified by repositioning the electrodes or more easily by a change of electrode polarity. In a prospective randomized cross-over study, the effect of transvenous electrode polarity on DFT was evaluated. Methods and Results: In 21 patients receiving transvenous-subcutaneous defibrillation leads, the DFT was determined intraoperatively for two electrode configurations. Two monophasic defibrillation pulses were delivered in sequential mode between either the right ventricular (RV) electrode as common cathode and the superior vena cava (SVC) and subcutaneous electrodes as anodes (configuration I) or the SVC electrode as common cathode and the RV and subcutaneous electrodes as anodes (configuration II). In each patient, both electrode configurations were used alternately with declining energies (25, 15, 10, 5, 2 J) until failure of defibrillation occurred. The DFT did not differ between both configurations (18.3 ± 8.2 J vs 18.9 ± 8.9 J; P = 0.72). Eleven patients had the same DFT with both electrode configurations, 5 patients a lower DFT with the RV electrode as cathode, and 5 patients a lower DFT with the SVC as cathode. Four patients had a sufficiently low DFT ( ≤ 25 J) with only 1 of the 2 configurations. Conclusion: A change of electrode polarity of transvenous-subcutaneous defibrillation electrodes may result in effective defibrillation if the first electrode polarity tested fails to defibrillate. In general, neither the RV electrode nor the SVC electrode is superior if used as a common cathode in combination with a subcutaneous anodal chest patch. [ABSTRACT FROM AUTHOR]

Introduction: For current implantable defibrillators, the nonthoracotomy approach to implantation fails in a substantial number of patients. In a prospective randomized cross-over study the defibrillation efficacy of a standard monophasic and a new biphasic waveform was compared for different lead configurations. Methods and Results: Intraoperatively, in 79 patients receiving nonthoracotomy defibrillation leads, the defibrillation threshold was determined in the initial lead configuration for the mono-and biphasic waveform. In each patient, both waveforms were used alternately with declining energies (20, 15,10, 5 J) until failure of defibrillation occurred. Three different initial lead configurations were tested in different, consecutive, nonrandomized patients using a bipolar endocardial defibrillation lead alone (A; n = 36) or in combination with a subcutaneous defibrillation patch (B; n = 24) or array (C; n = 19) lead. The lowest successful defibrillation energy with the biphasic waveform was less than, equal to, or higher than with the monophasic waveform in 64%, 28%, and 8% of patients, respectively, and on average significantly lower with the biphasic waveform for all three lead configurations (A: 11.3 ± 4.4 J vs 14.5 ± 4.5 J; B: 9.7 ± 4.7 J vs 15.1 ± 4,5 J; C: 7.9 ± 4.5 J vs 12.4 ± 4.9 J). Defibrillation efficacy at 20 J was significantly improved by the biphasic waveform (91% vs 76%). Conclusion: In combination with nonthoracotomy defibrillation leads, the biphasic waveform of a new implantable cardioverter defibrillator showed superior defibrillation efficacy in comparison to the standard monophasic waveform. Defibrillation thresholds were improved for lead systems with and without a subcutaneous patch or array lead. [ABSTRACT FROM AUTHOR]

Adequate sensing is a basic requirement for appropriate therapy with ICDs. Integrated sense pace defibrillation leads, which facilitate ICD implantation, show a close proximity of sensing and defibrillation electrodes that might affect the sensing signal amplitude by the high currents of internal defibrillation. In 99 patients, we retrospectively examined two integrated sense pace defibrillation leads, either both with a distance of 6 mm between the tip of the lead (sensing cathode) and the right ventricular defibrillation electrode (sensing anode) or one with a distance of 12 mm. Three seconds after a shock of 20 J, mean sensing signal amplitude during sinus rhythm (SR) decreased from 10.5 ± 4.3 mV to 5.1 ± 3.7 mV (P < 0.001) for the 6-mm lead, but showed no significant decrease for the 12-mm lead. The degree of signal reduction was inversely related to the time passed since defibrillation. Significant differences in reduction of sensing signal amplitude concerning monophasic and biphasic shocks could not be observed. Mean sensing signal amplitude of VF after shocks that failed to terminate it decreased in the same order as during SR (from 8.3 ± 4.1 mV to 4.1 ± 3.2 mV), but resulted in no failure of redetection during ongoing VF. DFTs did not differ for the 6-mm and the 12-mm lead. In conclusion, close proximity of the right ventricular defibrillation coil to the sensing tip of an integrated sense pace defibrillation lead causes energy and time related reductions in sensing signal amplitude after defibrillation, and might cause undersensing in the postshock period. A new lead design with a more proximal position of the right ventricular defibrillation coil avoids these problems without impairing DFTs. [ABSTRACT FROM AUTHOR]

The volume of current implantable cardioverter defibrillators (ICD) is not convenient for pectoral implantation. One way to reduce the size of the pulse generator is to find a more effective defibrillation pulse waveform generated from smaller volume capacitors. In a prospective randomized crossover study we compared the step-down defibrillation threshold (DFT) of a standard biphasic waveform (STD), delivered by two 250- μF capacitors connected in series with an 80% tilt, to an experimental biphasic waveform delivered by a single 450- μF capacitor with a 60% tilt. The experimental waveform delivered the same energy with a lower peak voltage and a longer duration (LVLD). Intraoperatively, in 25 patients receiving endocardial (n = 12) or endocardial-subcutaneous array (n = 13) defibrillation leads, the DFT was determined for both waveforms. Energy requirements did not differ at DFT for the STD and LVLD waveforms with the low impedance (32 ± 4 ℧) endocardial-subcutaneous array defibrillation lead system (6.4 ± 4.4 J and 5.9 ± 4.2 J, respectively) or increased slightly (P = 0.06) with the higher impedance (42 ± 4℧ ) endocardial lead system (10.4 ± 4.8 J and 12.7 ± 5.7 J, respectively). However, the voltage needed at DFT was one-third lower with the LVLD waveform than with the STD waveform for both lead systems (256 ± 85 V vs 154 ± 51 V and 348 ± 76 V vs 232 ± 54 V, respectively). Thus, a single capacitor with a large capacitance can generate a defibrillation pulse with a substantial lower peak voltage requirement without significantly increasing the energy requirements. The volume reduction in using a single capacitor can decrease ICD device size. [ABSTRACT FROM AUTHOR]

For most nonthoracotomy defibrillation lead systems, the transvenous anode can be positioned independently of the right ventricular (RVJ cathode. Usually a vertical position in the superior vena cava (SVC) is chosen. however, it is unknown if this position yields the optimal defibrillation threshold (DFT). Therefore, in 15 patients undergoing defibrillator implantation the SVC position was compared in a crossover study design with a horizontal position in the left brachiocephalic vein (BCV). Mean DFT was not different for SVC and BCV (19.2 ± 9.6 J vs 18.5 ± 9.1 J) but DFT of individual patients differed by up to 12 joules. A positive correlation between impedance and DFT in the BCV position (r = 0.6; P ≤ 0.05) indicated that the improved geometry of the defibrillation field with the BCV position is opposed by a higher impedance found for this position (63 ± 15 Ω vs 52 = 7 Ω). Thus, defibrillation is not improved in general although individual patients might benefit. [ABSTRACT FROM AUTHOR]

Waveforms. Defibrillation of the heart is achieved if an electrical current depolarizes the majority of the unsynchronized fibrillating myocardial cells. The applied current or the corresponding voltage described as a function of time is called the waveform. In pacing, to stimulate myocardial cells close to the electrode, a relatively low voltage is needed for a relatively brief duration. However, in defibrillation, approximately a 100-fold higher voltage is needed and achieved by the use of capacitors. The exponential voltage decay of a capacitor during its discharge determines the basic waveform for defibrillation. In an attempt to lower the energy needed for defibrillation. the steepness of the decay (different capacitances), the duration (fixed duration waveforms) or tilt (fixed tilt waveforms), or the initial polarity can be changed. Additionally, the polarity of the electrodes can be reversed during the discharge of the capacitor once (biphasic waveform) or twice (triphasic waveform). If two capacitors and defibrillation pathways are available, bidirectional defibrillation pulses can be delivered sequentially. In humans, the original standard waveform used with endocardial leads was a single monophasic pulse delivered by a 125-µF capacitor using the endocardial right ventricular electrode as cathode. It is now known that a reversal of the initial polarity and a reversal of polarity during capacitor discharge may significantly lower the energy needed for defibrillation, thereby preventing formerly frequent failures of defibrillation with endocardial lead systems. The use of sequential pulses showed no or only slight reductions of energy requirements and was abandoned due to the additional electrode needed The use of a smaller capacitance (60-90 µF) reduced maximum energy output but generally did not reduce energy requirements for defibrillation. However, with more efficient electrodes, smaller capacitances that will help to reduce the size of the defibrillator might be used. Thus, today defibrillation is optimized with respect to energy, capacitor size, and ease of implantation if an approximately 90-µF capacitor is used to deliver a biphasic pulse via a bipolar lead system using the right ventricular electrode as anode. [ABSTRACT FROM AUTHOR]

Explains that several treatment options are available for patients with depending on the presenting ventricular tachyarrhythmia, the type, extent, and severity of the underlying cardiac disorder, age and sex, concomitant noncardiac diseases, and previous failures of therapeutic approaches. Antitachycardia surgery; Catheter ablation; Implantable cardioverter-defibrillator.

The present study reports on the complementary role of two nonpharmacological options of antiarrhythmic therapy. Background: Catheter ablation, antitachycardia surgery, and the implantable cardioverter defibrillator (ICD) have become important tools in the management of ventricular tachyarrhythmias. However, the emergence of ventricular tachyarrhythmias after implantation of an ICD is possible because the arrhythmogenic substrate is not affected. Patients and Methods: Six of 180 patients developed frequent episodes of monomorphic ventricular tachycardia (n = 2) or incessant ventricular tachycardia (n = 4) following implantation of an ICD and underwent radiofrequency (RF) catheter ablation. Catheter ablation was performed using a RF generator HAT 200. Energy was delivered between a 4-mm tip electrode of the ablation catheter and a patch electrode. Results: Catheter ablation was done 6.8 ± 5 months following ICD implantation; 6 ± 2.2 RF impulses were delivered at the site of origin of ventricular tachycardia chararcterized by early endocardial activation during ventricular tachycardia, identical pace mapping and long latency between stimulus, and QRS-complex in five patients. New bundle branch reentry was the underlying mechanism of ventricular tachycardia in one patient. RF catheter ablation resulted in termination of incessant ventricular tachycardia. Immediately postablation, the documented ventricular tachycardia was rendered noninducible in all patients. No ICD malfunctions have been observed. One patient died due to heart failure 24 hours after successful ablation of the incessant ventricular tachycardia. During a follow-up of 5-19 months, episodes of ventricular tachycardia recurred in four patients. All episodes could be controlled by the ICD without frequent cardioversions. Conclusion: RF catheter ablation is o complementary therapeutic option in case of frequent or incessant ventricular tachycardia after ICD implantation. [ABSTRACT FROM AUTHOR]

The article presents a study of 72 transvenous-subcutaneous implantations obtained within multicenter trials. Between October 10, 1989 and September 5, 1991, transvenous-subcutaneous leads were tested in 72 patients. A transvenous-subcutaneous lead system was implanted in 64 of these 72 patients All patients had at least one episode of documented sustained VT/VF of which 55 had survived sudden cardiac death. Antiarrhythmic drugs had failed to control VT/VF in 65 patients, catheter ablations in 7 patients, and antitachycardia surgery in 4 patients. Implantations of the defibrillators were done in a cardiovascular operating room under general anesthesia. In 69 patients optimal pacing and sensing was obtained.

Presents information on the results of the Morbidity and Mortality after Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention (MOSES) study. Comparison between the angiotensin II receptor blocker eprosartan and the calcium channel blocker nitrendipine in treating hypertensive patients; Study methods; Uniqueness of the MOSES study.

We report an unusual case of the erroneous discharge of a third-generation multiprogrammable implantable cardioverter defibrillator in a 64-year-old patient with a history of recurrent ventricular tachycardias caused by electromagnetic interference while shaving with an electric razor. Electromagnetic interference was related to a defect in the electrode's insulation and could not be provoked in an intact electrode. [ABSTRACT FROM AUTHOR]

Im ersten Jahrgang von Physik in unserer Zeit im Jahre 1970 erschien eine Meldung zur Namensgebung des superschweren Elements 105. Was wurde daraus, und wo stehen wir heute? [ABSTRACT FROM AUTHOR]

Am GSI Helmholtzzentrum für Schwerionenforschung in Darmstadt ist erstmals die direkte Messung der Stärke von Schaleneffekten in sehr schweren Atomkernen mit über 100 Protonen gelungen. Durch hochpräzise Massenmessungen an den Transuranen Nobelium und Lawrencium konnten diese Schaleneffekte für 152 Neutronen bestimmt werden. Die Ergebnisse liefern Informationen über die Kernstruktur superschwerer Elemente und dienen dazu, die Vorhersagen über Lage und Ausdehnung der 'Insel der Stabilität' zu verbessern. [ABSTRACT FROM AUTHOR]

An implantable cardioverter defibrillator was placed info a subpectoral pocket via the incision for cephalic venotomy during implantation of a nonthoracotomy lead system. The approach obviated another incision and subcutaneous tunneling of the leads. There were no perioperative complications and after 6 months off follow-up, the patient continues to tolerate the device satisfactorily. [ABSTRACT FROM AUTHOR]

Contaminant bioavailability via digestive exposure was examined for 18 species of marine benthic invertebrates, using incubation of digestive fluids with sediments that were spiked with either radiolabeled benzo-[a]-pyrene (BaP) or zinc. Interphyletic trends in contaminant solubilization were compared with measures of digestive biochemistry, including enzyme activities, surfactancy, pH, and fluid phase organiccarbon, amino acids, and lipids. Contaminant solubilization ranged from values equal to that of a seawater control to as much as an orderof magnitude higher but were lower than those obtained with commonlyused chemical extractants. Digestive fluids from echinoderms and a cnidarian tended to be relatively weak, those from polychaetes and echiurans were relatively strong, and those from taxa such as sipunculans and mollusks were intermediate. These trends correlated strongly with concentrations or activities of digestive biochemicals but not with pH. These correlations are consistent with previous work on mechanisms of digestive solubilization of polycyclic aromatic hydrocarbons (PAH) and metals, though strong covariance among digestive parameters does not allow this approach to be used for identification of specific mechanism(s). [ABSTRACT FROM AUTHOR]

In the title compound, [Sn(C(6)H(5))(3)(C(10)H(13)OS)]·0.17C(6)H(6), the Sn(IV) atom exhibits a slightly distorted tetra-hedral coordination geometry built up by four C atoms, which are the three ipso-C atoms of the phenyl rings and the α-C atom of the deprotonated γ-O-functionalized propyl phenyl sulfide. The benzene mol-ecule lies about a threefold rotoinversion axis.

In the title complex, [Rh(C(6)H(16)P(2))(2)][RhCl(2)(C(8)H(12))], the asymmetric unit contains two [Rh(dmpe)(2)] [dmpe = 1,2-bis-(dimethyl-phosphino)ethane] half-cations, lying on inversion centers, and an [RhCl(2)(cod)](-) (cod = 1,5-cyclo-octa-diene) anion, wherein Rh is coordinated by two chloride ligands and two olefinic π-bonds of the cyclo-octa-diene ligand. The Rh atoms in the cations and anion exhibit square-planar coordination and are separated without any unusual inter-actions.