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Interference of programmed electromagnetic stimulation with pacemakers and automatic implantable cardioverter defibrillators.

A commercially available magnetic therapy system, designed for clinical application as well as for private use without medical supervision, was examined with respect to its potential for causing electromagnetic interference with implantable pacemakers (PMs) and automatic implantable cardioverter defibrillators (AICDs). A sample of 15 PMs and 5 AICDs were experimentally investigated. Each of the implants was realistically positioned in a homogeneous, electrically passive torso phantom and exposed to the magnetic fields of the system's applicators (whole body mat, cushion, and bar applicator). The detection thresholds of the implants were programmed to maximum sensitivity and both unipolar as well as bipolar electrode configurations were considered. The evaluation of possible interferences was derived from the internal event storages and pacing statistics recorded by the implants during exposure. Any "heart activity" recorded by the implants during exposure was interpreted as a potential interference, because the implant obviously misinterpreted the external interference signal as a physiological signal. Only cases without any recorded "heart activity" and with nominal pacing rates (as expected from the program parameter settings) of the implants were rated as "interference-free." Exposure to the whole body mat (peak magnetic induction up to 265 microT) did not show an influence on PMs and AICD in any case. The cushion applicator at the highest field intensity (peak magnetic induction up to 360 microT) led to atrial sensing defects in four PM models with unipolar electrode configuration. Under bipolar electrode configuration no disturbances occurred. The bar applicator led to sensing problems and consecutively reduced pacing rates in all tested PM models under unipolar electrode configuration and maximum field intensity (peak magnetic induction up to 980 microT). Bipolar electrode configuration resolved the problem. The investigated AICDs did not show malfunctions under any investigated condition. In conclusion, the examined PEMF therapy system did not interfere with the investigated implantable cardiac devices with bipolar electrode configuration. However, unipolar electrode configuration in pacemakers seems to be potentially hazardous during application of the examined PEMF therapy system.

Defibrillators, Implantable↗

Current densities measured in human models exposed to 60-Hz electric fields.

This paper gives current densities measured in homogeneous grounded human models exposed to vertical, 60-Hz electric fields. The methods used for these measurements were validated by measuring the current densities induced in a grounded hemisphere and in a grounded prolate hemispheroid; agreement between measurement and theory was good. For an unperturbed field strength of 10 kV/m, current densities measured in the human chest were in the range 125-300 nA/cm2. A strong horizontal current-density enhancement was observed in the axillae, with peak values of about 400 nA/cm2. The vertical current density in the arms, when held downward, was in the opposite direction to that in the chest. Current densities in the abdomen, pelvis, and legs were a strong function of whether the body was grounded through one or both feet. With one foot grounded, the horizontal current density in the lower pelvic region, just above the crotch, was 770 nA/cm2. This value was the largest of those measured in the head, arms, or torso of the human model. Scaling factors derived from these data and similar data for animals will provide a quantitative basis for comparing animal and human exposure to 60-Hz electric fields. In addition, current-density data given in this paper can be directly extrapolated to higher frequencies, at least to 1 MHz. These extrapolated data may be useful to individuals and groups involved in the determination of safety standards for the lower radiofrequency region.

Electricity↗

Specific absorption rate in models of man and monkey at 225 and 2,000 MHz.

Full-size models of a man and a rhesus monkey were exposed to radiofrequency (RF) radiation at 225 MHz. The model of man was also exposed to 2,000 MHz. Specific absorption rates (SARs) were measured in partial-body sections, such as the arms, legs, etc., using gradient-layer calorimeters. Also, front-surface thermographic images were obtained to qualitatively show the heating patterns. For all of the configurations used, the SAR in the limbs was much higher than in the torso. Agreement (whole-body SARs) with spheroidal models was better for both models at 225 MHz than at 2,000 MHz. These results indicate that in the frequency range two orders of magnitude above whole-body resonance, SAR in the limbs significantly contributes to the whole-body average SAR.

Animals↗

William Hunter's casts of the gravid uterus at the University of Glasgow.

The Hunterian Collection at the University of Glasgow possesses 11 plaster casts showing the pregnant uterus. Three correspond to Plates I, IV, and VI of Hunter's The Anatomy of the Gravid Uterus Exhibited in Figures (1774), progressive stages of dissection of the same specimen. A further three casts show consecutive stages of dissection of a uterus containing a fetus presenting by the breech. The other specimens show a normal pregnancy at about 6 months, a normal full-term uterus with the fetal head becoming engaged, a breech presentation with placenta previa and the umbilical cord around the fetal neck, and an obstructed labor with distended bladder and colon. The 10 on display show realistic coloring and are mounted on black wooden stands. An 11th specimen, amateurishly painted, is not on display. The casts differ in their style; some show only the abdomen, pelvis, perineum, and thighs, others show the full torso. They also differ in the amount of detail shown. The first three casts show the cut femur and muscles at the transected ends of the thighs, also shown in some of the plates in the Gravid Uterus. Although these features enhance the artistic impact of both the engravings and the casts, the authors are unconvinced that Hunter deliberately used them to achieve this, as has been claimed.

Adult↗

Treatment of postmastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled trial.

BACKGROUND: The current study describes the results of a double blind, placebo-controlled, randomized, single crossover trial of the treatment of patients with postmastectomy lymphedema (PML) with low-level laser therapy (LLLT). METHODS: Participants received placebo or one cycle or two cycles of LLLT to the axillary region of their affected arm. They were monitored for reductions in affected limb volume, upper body extracellular tissue fluid distribution, dermal tonometry, and range of limb movement. RESULTS: There was no significant improvement reported immediately after any of the treatments. However, the mean affected limb volume was found to be significantly reduced at 1 month or 3 months of follow-up after 2 cycles of active laser treatment. Approximately 31% of subjects had a clinically significant reduction in the volume of their PML-affected arm (> 200 mLs) approximately 2-3 months after 2 cycles of treatment. There was no significant effect of placebo treatment, or one cycle of laser treatment, on affected limb volume. The extracellular fluid index of the affected and unaffected arms and torso were reported to be significantly reduced at 3 months after 2 cycles of laser therapy, and there was significant softening of the tissues in the affected upper arm. Treatment did not appear to improve range of movement of the affected arm. CONCLUSIONS: Two cycles of laser treatment were found to be effective in reducing the volume of the affected arm, extracellular fluid, and tissue hardness in approximately 33% of patients with postmastectomy lymphedema at 3 months after treatment.

Adult↗

Postnatal regulation of limb proprioception by muscle-derived neurotrophin-3.

To investigate the effects of neurotrophin-3 (NT-3) on postnatal proprioceptive neurons and their targets, transgenic mice were generated that use the myosin light chain 1 (mlc) promoter to overexpress NT-3 in skeletal muscle. Ribonuclease protection assays revealed that NT-3 overexpression in hindlimb skeletal muscle began at embryonic day 14 (E14) and continued throughout adulthood. Overexpression of NT-3 during late embryogenesis resulted in increased numbers of large sensory and small fusimotor axons. Within a week of birth, mlc/NT-3 mice retract their limbs to the torso when lifted by the tail. Footprint analysis revealed that mlc/NT-3 mice had significant abnormalities in their gait compared with wild-types. Beam walking and rotorod analysis confirmed the poor limb control by mlc/NT-3 mice. These locomotive deficits progressively worsened with age and were likely related to the formation of morphologically abnormal muscle spindles. The most common spindle anomaly was the presence of excessive intrafusal bag fibers within individual muscle spindles. To assess the role of NT-3 in recovery from nerve injury, sciatic nerve crushes were performed in young adult mice. Two days after injury, mlc/NT-3 mice displayed significantly improved sciatic functional indexes and a significant increase in muscle spindles that remained associated with axons. The latter finding suggests that excess NT-3 in muscle may retard the degeneration of proprioceptive axons after nerve crush. Long-term survival after nerve injury in mlc/NT-3 mice did not induce further changes in spindle number or morphology. These findings demonstrate that, in addition to promoting embryonic proprioceptive neuron survival, postnatal overexpression of NT-3 in muscle leads to abnormal spindle formation and deficits in locomotive control. However, our results also show that NT-3 may be therapeutic for proprioceptive axons immediately after nerve injury by delaying axon degeneration.

Animals↗

Spontaneous motility in premature infants: features of behavioral activity and rhythmic organization.

The spontaneous motor activity of clinically stable premature infants, 26-36 weeks gestational age, was investigated. Movements were recorded using a pressure-sensitive transducer positioned below the infant's head and torso. Behavior samples were digitized every 0.5 s during 2 and 3-hr continuous recording sessions. Time-series analyses revealed prominent motility cycles of circa 80 min and circa 30 min. These results are consistent with periodicities in motility and REM activation observed in full-term neonates. The longer rhythms of 70-100 min of motility found in this study establish that these periods are present at this stage of development independent of maternal zeitgebers. Developmental changes in motility rhythms and movement burst durations were also observed. Bout durations became somewhat longer in older (> 30 weeks) infants, but the relative time devoted to movement per session was comparable in older and younger (< or = 30 weeks) infants.

Age Factors↗

Management of complicated head and neck wounds with vacuum-assisted closure system.

BACKGROUND: The vacuum-assisted closure system (V.A.C.), or negative pressure dressings, has been successfully used to manage complex wounds of the torso and extremities, but its role in the head and neck region has not been frequently described. METHODS: A retrospective study was performed. The V.A.C. system (Kinetic Concepts Inc., San Antonio, TX) was used at the University of Iowa Hospitals and Clinics for management of complicated head and neck wounds. RESULTS: The V.A.C. system was utilized at 13 sites for 12 patients. Nine subjects had exposed calvarium (4 had failed pedicled reconstructive flaps, 3 had ablative or Moh's defects, and 2 had traumatic scalping injuries) necessitating bony coverage. Three subjects had the V.A.C. system used as a bolster dressing placed over split-thickness skin grafts (STSGs) used to reconstruct large defects of the face and skull, and 1 patient had a large soft tissue neck defect after radical surgical resection for necrotizing fascitis. One subject used the V.A.C. system for the management of 2 distinct wounds. All patients had successful healing of their wounds with the V.A.C. system without complication. All STSGs had 100% viability after 5 to 7 days of the V.A.C. system use as a bolster dressing. CONCLUSION: This study demonstrates the V.A.C. system is a valuable tool in the management of complicated head and neck wounds.

Adult↗

Testosterone pharmacokinetics after application of an investigational transdermal system in hypogonadal men.

This open-label, randomized, placebo lead-in, three-treatment crossover study in 19 hypogonadal men (27-82 years of age) evaluated dose proportionality of serum testosterone concentrations with application of one or two investigational transdermal testosterone systems for application to the arm or torso. Testosterone in vivo kinetics profiles were determined using DeMonS, a recently developed numerical deconvolution method that estimates drug absorption at different time intervals and/or drug disposition model parameters. After application of the investigational transdermal systems, the mean serum testosterone, dihydrotestosterone, estradiol, and free testosterone concentrations were elevated to normal levels. Treatment allowed approximation of the normal circadian pattern of endogenous testosterone secretion, and the increase in serum testosterone concentrations was proportional to the surface area of systems applied. The investigational transdermal system provided effective testosterone replacement therapy as judged by pharmacokinetic parameters.

Administration, Cutaneous↗

A teaching phantom for sonographers.

An anthropomorphic torso section phantom is described that is intended for use during initial stages of ultrasonographer training. The phantom represents a section of the upper abdomen, with simulated ribs, liver, kidney with fat pad, gallbladder, aorta, and bowel gas. Positioned in the liver are ten simulated soft tissue masses, which produce a variety of typical echographic patterns. All simulated soft tissue components are formed of tissue-mimicking materials that match their corresponding tissue counterparts in terms of speed of sound, ultrasonic attenuation, and density. Construction details are presented and examples of images are shown.

Abdomen↗

Neurostimulation systems for deep brain stimulation: in vitro evaluation of magnetic resonance imaging-related heating at 1.5 tesla.

PURPOSE: To assess magnetic resonance imaging (MRI)-related heating for a neurostimulation system (Activa Tremor Control System, Medtronic, Minneapolis, MN) used for chronic deep brain stimulation (DBS). MATERIALS AND METHODS: Different configurations were evaluated for bilateral neurostimulators (Soletra Model 7426), extensions, and leads to assess worst-case and clinically relevant positioning scenarios. In vitro testing was performed using a 1.5-T/64-MHz MR system and a gel-filled phantom designed to approximate the head and upper torso of a human subject. MRI was conducted using the transmit/receive body and transmit/receive head radio frequency (RF) coils. Various levels of RF energy were applied with the transmit/receive body (whole-body averaged specific absorption rate (SAR); range, 0.98-3.90 W/kg) and transmit/receive head (whole-body averaged SAR; range, 0.07-0.24 W/kg) coils. A fluoroptic thermometry system was used to record temperatures at multiple locations before (1 minute) and during (15 minutes) MRI. RESULTS: Using the body RF coil, the highest temperature changes ranged from 2.5 degrees-25.3 degrees C. Using the head RF coil, the highest temperature changes ranged from 2.3 degrees-7.1 degrees C.Thus, these findings indicated that substantial heating occurs under certain conditions, while others produce relatively minor, physiologically inconsequential temperature increases. CONCLUSION: The temperature increases were dependent on the type of RF coil, level of SAR used, and how the lead wires were positioned. Notably, the use of clinically relevant positioning techniques for the neurostimulation system and low SARs commonly used for imaging the brain generated little heating. Based on this information, MR safety guidelines are provided. These observations are restricted to the tested neurostimulation system.

Brain↗

Magnetic resonance safety testing of a newly-developed fiber-optic cardiac pacing lead.

PURPOSE: To assess magnetic resonance (MR) safety for a newly developed, fiber-optic cardiac pacing lead. MATERIALS AND METHODS: MR safety was assessed for the fiber-optic cardiac pacing lead by evaluating magnetic field interactions and heating. Translational attraction and torque were evaluated using a 1.5-Tesla MR system and previously described, standardized techniques. MR imaging-related heating was assessed using a 1.5-Tesla MR system and a transmit/receive, body radiofrequency (RF) coil with the fiber-optic lead positioned to simulate an in vivo condition in a saline-filled phantom. The phantom had dimensions similar to a human subject's torso and head. A fluoroptic thermometry system was used to record temperatures on and near the electrodes of the fiber-optic pacing lead at five-second intervals immediately before and during 20 minutes of MR imaging performed at a whole-body-averaged specific absorption rate (SAR) of 1.5 W/kg. Temperatures were also recorded from a reference site during this experiment. RESULTS: Magnetic field interactions for the fiber-optic lead were minimal (deflection angle, 23 degrees; torque, +2). The highest temperature change recorded for the fiber-optic cardiac pacing lead and reference site was +0.8 degrees C. CONCLUSION: The minor magnetic field interactions and relative lack of heating for the fiber-optic pacing lead indicate that it should be safe for patients with this device to undergo MR imaging procedures using MR systems operating at 1.5-T or less and at a whole-body-averaged SARs up to 1.5 W/kg.

Electrodes↗

Evaluation of specific absorption rate as a dosimeter of MRI-related implant heating.

PURPOSE: To compare the magnetic resonance imaging (MRI)-related heating per unit of whole body averaged specific absorption rate (SAR) of a conductive implant exposed to two different 1.5-Tesla/64 MHz MR systems. MATERIALS AND METHODS: Temperature changes at the electrode contacts of a deep brain stimulation lead were measured using fluoroptic thermometry. The leads were placed in a typical surgical implant configuration within a gel-filled phantom of the human head and torso. MRI was performed using two different transmit/receive body coils on two different generation 1.5-Tesla MR systems from the same manufacturer. Temperature changes were normalized to whole body averaged SAR values and compared between the two scanners. RESULTS: Depending on the landmark location, the normalized temperature change for the implant was significantly higher on one MR system compared to the other (P < 0.001). CONCLUSION: The findings revealed marked differences across two MR systems in the level of radiofrequency (RF)-induced temperature changes per unit of whole body SAR for a conductive implant. Thus, these data suggest that using SAR to guide MR safety recommendations for neurostimulation systems or other similar implants across different MR systems is unreliable and, therefore, potentially dangerous. Better, more universal, measures are required in order to ensure patient safety.

Body Temperature↗

SENSE imaging with a quadrature half-volume transverse electromagnetic (TEM) coil at 4T.

PURPOSE: To demonstrate the feasibility of high-field SENSE imaging of large objects, such as the human head, using a semicircular (half-volume) coil for both transmission and multi-channel reception. MATERIALS AND METHODS: As a proof of concept, we present experimental data obtained using a seven-element half-volume (180 degrees of arc) transmit/receive quadrature transverse electromagnetic (TEM) coil. SENSE images of the human brain were acquired with a reduction factor of R=2, using two degenerate linear modes of the same coil as independent receive channels at 4T. Since the need for additional hardware (i.e., a separate set of receive coils) is eliminated, the design can be substantially simplified. RESULTS: The experimental data demonstrate that linear modes of the half-volume TEM coil have essentially no noise correlation, and their sensitivity profiles satisfy the requirement for small g-factors. Also, this type of coil provides efficient transmission with a relatively large uniform region and a reception profile that is more uniform than that of the surface coils. CONCLUSION: We demonstrate the feasibility of SENSE imaging using a half-volume coil. Half-volume coils allow reduced total power deposition compared to full-volume coils, and may replace the latter in body imaging applications in which the target region of interest (ROI) is smaller than the entire torso.

Brain Mapping↗

Variability in RF-induced heating of a deep brain stimulation implant across MR systems.

PURPOSE: To compare the MRI-related heating per unit of specific absorption rate (SAR) profile of a conductive implant between two 1.5-Tesla/64 MHz MR systems using a transmit/receive (t/r) head coil configuration. MATERIALS AND METHODS: Deep brain stimulation (DBS) leads were configured within a gel-filled phantom of the human head and torso. Temperature variation at each of four contacts of the bilaterally-placed leads was monitored using fluoroptic thermometry. MRI was performed using the t/r head coils of two different-generation 1.5-Tesla MR systems from the same manufacturer. Temperature changes were normalized to SAR values for the head (DeltaT/SAR-H), and the slope of this DeltaT/SAR-H by time relationship was compared between the two scanners. RESULTS: The DeltaT/SAR-H for the implant ranged from 3.5 to 5.5 times higher on one MR system as compared to the other (P < 0.01) depending on the measurement site. CONCLUSION: The findings support previous observations that console-reported SAR does not constitute a reliable index of heating for elongated, conductive implants, such as the DBS hardware system tested. In contrast to our previous findings using a t/r body coil, the data presented here reveal marked differences between two MR systems using t/r head coils (the coil configuration was consistent with the implant manufacturer's imaging guidelines). J. Magn. Reson. Imaging 2006. (c) 2006 Wiley-Liss, Inc.

Body Temperature↗

Partial characterization of a brain extract factor(s) inhibitory to transformed neural cells.

The factor(s) present in extracts prepared from the brains of newborn A/J or C57B1/6 mice, which inhibits S20Y neuroblastoma cell growth in vitro, was partially characterized. Twice as much inhibitory activity was extracted per gram wet weight of brain than torso, and inhibitor recovery was greatest in extracts prepared from brains of mice 1 week or less in age. The inhibitory factor(s) was water-soluble and was stable to heating at 100 degrees C, to freezing, and to lyophilization. It was susceptible to the action of pronase. The factor(s) behaved like a molecule of molecular weight approximately 700 upon passage through ultrafiltration membranes. Growth of rat hepatoma (H4), murine melanoma (B16), and transformed murine fibroblasts (WT19 and B6-HCMV) was not significantly inhibited by brain extract. Growth of rat glioma cells (C6) was significantly reduced but to a lesser degree than that of murine neuroblastoma cells (S20Y and N115) and glioma cells (G26-20). These results suggest that the inhibitor expresses a cell specificity.

Animals↗

Hemicorporectomy: a collective review.

Hemicorporectomy or translumbar amputation has been described as the most revolutionary of all operative procedures. Frederick E. Kredel, who first voiced the concept of the operation in 1950, referred to it as halfectomy. Demonstration of his cadaver studies established the feasibility of the operation. Amputation is effected through the lower lumbar area of the body. Necessary life functions are preserved in the upper torso. Kredel envisioned hemicorporectomy as a curative operation for locally advanced cancer, limited to the pelvis, not encompassable by standard operative intervention. Additional indications are intractable decubitus ulcers with malignant change, particularly in paraplegics; pelvic organs, and bone infection with nonhealing fistulae; and crushing trauma to the pelvis. The first hemicorporectomy operation was reported in 1960. Thirty-four operations have been recorded in the world literature. Two heretofore unreported cases are added, raising the total to 36. Review of these 36 cases confirms the conviction that hemicorporectomy is a humane and ethical alternative to the suffering encumbered by advancing, painful, malodorous malignant disease not treatable by conventional means. While cure rates are not substantial, the best results are reported in paraplegics with intractable decubitus ulcers with or without malignancy. Rehabilitation is prolonged and costly. Most survivors have been restored to preoperative occupations or other gainful employment.

Amputation, Surgical↗

Proximal and distal reaction times (RTs) are not differentially affected in Parkinson's disease.

The hypothesis was tested that proximal and distal reaction times (RTs) might be differentially affected in Parkinson's disease (PD). Twelve patients with PD were compared with 12 age-matched healthy controls on tests of finger-, hand-, leg-, and torso-RTs. Patients were significantly slower in initiating all movements and were slower in executing all movements except for the leg (stepping) task. Choice- versus simple-RTs were also not differentially affected in the PD group. In the healthy subjects, age was significantly positively correlated with response initiation times (RITs) but not with movement times (MTs).

Aged↗