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At least 19 recordsLinked to original sources

Radiographic aspects of permanent cardiac pacemakers.

Radiographic findings in patients with permanent cardiac pacemakers are described, and recent advances in pulse generator and lead design are presented. Emphasis is placed on those findings which are related to (a) complications of cardiac pacing, (b) radiographic configurations of new energy sources and lead/electrode systems, and (c) a new system of pulse generator identification.

Bioelectric Energy Sources

Rechargeable silver-modified mercuric oxide-zinc cell for cardiac pacemakers.

Tests were conducted on rechargeable mercury-zinc pacemaker batteries under simulated and actual biologic conditions, using a variety of discharge rates and charging schedules. In tests on 96 cells at a 6.4 milliampere (ma) discharge, recharging once every 15 months of simulated pacing at a 25 microampere (mua) drain, the earliest cell failure occurred after an equivalent of 50 years of pacing. The mean pacing equivalent for all 96 cells was more than 140 years. In 6.4 ma discharge tests on 24 cells, recharging once every 8 days of simulated pacing, only 1 cell in 24 failed after an equivalent of more than 500 years of pacing (actual time 2 years). In tests on 13 cells pacing at a 200 mua drain without recharging, the simulated mean duration of pacing before total discharge was 4.8 years. Seven other cells at a 200 mua drain with periodic recharging continue to function normally after more than 7 years of actual time, simulating 56 years of pacing at a 25 mua drain. Cardiac pacemakers using the rechargeable mercury-zinc cell have been implanted in animals for more than 2 1/2 years and in patients for more than 1 year with all units continuing to function satisfactorily. It has been demonstrated unequivocally that a rechargeable mercury-zinc pacemaker will function continuously for more than 4 years without recharging and that periodic recharging will extend pacing life far beyond that predicted for lithium and nuclear primary power sources.

Animals

[Recent progress in energy sources and in technology of electronic circuits (author's transl)].

Since 1957, when the first implantable pacemaker was developed, the performances of cardiac pacemakers have enormously improved. The paper describes the recent progress in the field of energy sources, technology and circuit solutions. The improvements achieved up to now have extended the mean life-time of an implantable pacemaker from about 30 months up to more than 6 years, while some pacemakers with programming capabilities are available and pacemakers with self-adapting capabilities to the individual hemodynamic needs are in the stage of advanced development.

Bioelectric Energy Sources

An implantable electromagnetic sound source for speech production.

Our goal is to provide laryngectomized cancer patients with a method of speech rehabilitation as an alternative to esophageal speech when required. With the cooperation of otolaryngologists, biomedical engineers, and speech therapists, an implantable electromagnetic sound source for voice production has been produced. It is biocompatible, durable, and functional in animal experimentation. A small, carefully selected clinical trial will soon begin.

Animals

Current status of pacemaker power sources.

After years during which pacers of very similar design and capabilities were provided by a small number of manufactures, many different lithium, halogen, rechargeable, and nuclear power sources are now available. The variety of chemistries, methods of construction, and sealing techniques used in the batteries of the different manufacturers is almost unlimited. This has made it necessary for physicians who implant and follow pacer to acquire a general knowledge of the field if they are to make an informed choice of pacemaker power source for implantation and if they are to manage recalls with a minimum of patient and physician trauma. More experience is required before it can be definitely determined which of the new pacer power sources will prove superior, but when coupled with well-designed, hermetically sealed pulse generators, all are capable of providing continuous pacing for at least 5 years and the 10-year pacemaker is now a probability.

Animals

Runaway pacemaker in seven patients: a persisting problem.

Runaway pacemaker has been encountered in 7 patients during the past 7 years at the Texas Heart Institute. In this series, 4 patients with fixed-rate pacemakers experienced pacemaker arrhythmias because of battery depletion, and 3 had arrhythmias because of component failure. Battery deterioration was heralded by an increase in cardiac rate. Ventricular tachycardia, rapidly followed by ventricular fibrillation, occurred in 2 patients. Prompt surgical exteriorization of the failing pulse generator and connection to an external pacemaker resulted in prompt recovery in all patients. Elective generator change should be performed routinely after 24 to 30 months unless reliable serial observations of ventricular rates can be attained. This at least will reduce the lethal complications attributed to battery exhaustion. Increasing developments in the design of generators and sources of power, as well as data from pacemaker clinic follow-up and telephone pulse transmittal, are expected to decrease the frequency of this complication.

Adult

A focus for biophysical research in energy problems.

There is widespread agreement that solar energy is the most promising long-range energy source. However, contemporary technology for bulk energy storage is so primitive that full use of the inevitably erratic solar energy flux is severely limited. Biological systems have perfected methods of storing solar energy for later use in periods of darkness, and it is argued in this symposium presentation that there are many frontiers in biophysics related to the solar energy storage problem. Moreover, the conceivable biological storage systems span a wide range of technology, with appropriate applications in societies of widely varying degrees of industrial development. Use of biological systems to produce hydrogen from solar energy may be among the most versatile of these applications. The entire problem of bioconversion of solar energy presents an excellent example of how the needs for basic scientific understanding and application engineering can be very tightly interwoven.

Bacteria

Hyaluronidase-bound membrane as a biomaterial for implantable fuel cells.

A new biomaterial containing covalently bound hyaluronidase was prepared. An application of this enzyme membrane is to improve the performance of an implantable fuel cell. Hyaluronic acid is a contributor to the viscosity of tissue fluids but can be a potential fuel source because of its sugar content. The incorporation of immobilized hyaluronidase would not only contribute to a more available fuel supply by splitting hyaluronic acid but, perhaps more importantly, enhance the rate of mass transport of fuel, O2, and reaction products by reducing the viscosity near the electrode membranes. Hyaluronidase was bound to Sepharose gel and its thermoplastic membrane after activation by cyanogen bromide. Fourteen and 22% of the activities were recovered from the gel and membrane, respectively. The activity of the bound enzyme was stable for six months at 0 degrees C. The addition of hyaluronic acid, 1 mg/ml, to a typical implantable type bioautofuel cell in vitro increased external solution viscosity from 1.1 to 2.5-2.8 cP and reduced voltage output under 10 komega by 60% in 3 hr. When the hyaluronidase bound membrane was placed at the anode, viscosity of the glucose-hyaluronic acid solution was lowered to 1.8 cP and the cell output increased to the original level of a glucose-fueled cell in 3 hr. Glucosamine-equivalent released from hyaluronic acid at the electrode was 3.1 mg after 22.5 hr. This represents 90% of the theoretical consumption. Restoration of the cell output was probably a combination of the enhanced transport of fuel, O2 and products, and/or appearance of a new fuel, glucosamine-equivalent.

Biocompatible Materials

Chronic testing of a pacemaker that needs recharging only once every four years.

Since 1967, three series of rechargeable single-cell silver-mercuric oxide-zinc pacemakers have been implanted in dogs with complete heart block. The five nonhermetic units in series 1 failed after less than or equal to 18 months, primarily due to prototype cell deficiencies, although one cell functioned for eight years. The six units in series II contained improved cells, but failed due to gradual transepoxy fluid absorption after less than or equal to 31 months. All rechargeable cells were salvaged and dried, and, seven years after their manufacture, they continue to power pacing circuits. Series III now totals 20 doubly hermetically sealed units, tested for up to three years (total more than 300 months or 26 years), with no pacemaker failures. Accelerated tests indicate a minimum life of more than 50 years. A clinical trial is in progress.

Animals

On the optimization of local hyperthermy in tumors based on a new radiofrequency procedure. Local hyperthermy of large body areas using the CMT selectotherm method.

A new radiofrequency procedure, i.c., the CMT Selectotherm technique, permits to convey large heat quantities per volume unit also to deep-seated tumor tissues without causing thermal lesions in healthy tissues near or at the body surface. The improved spatial homogeneity of energy supply attainable by this method is demonstrated by measurements at a gelatine phantom and, in particular, by in vivo measurements on pigs. The appliability of local hyperthermy to tumors localized in different parts of the body is substantially improved (a) by the principle of superimposing local hyperthermy on an elevated temperature level of metabolically induced whole-body hyperthermy (CMT-spontaneous hyperthermy at 40 degrees C) and (b) by the principle of selective increasing the thermal sensitivity of tumor tissues by decreasing the pH in these areas (the CMT main step). It is shown that the temperature dose T. deltat necessary for the selective occlusion of the vasculature in tumor tissues can be obtained by the CMT Selectotherm process also in deep-seated tumors. This process is part of the 1977 CMT concept. The fundamentals of optimizing local hyperthermy with consideration of heat dissipation from the tissue by heat conduction and convection via the blood stream are demonstrated. Temperature profiles are calculated for some practice-relevant, typical examples (inner and outer parts of sphero-symmetrically shaped tumors). Finally, in vivo measurements and calculations on the time course of temperature under certain conditions and for different tissue layers are discussed.

Bioelectric Energy Sources