Acoustic transmission of the respiratory system using speech stimulation.

Two methods for the analysis of the acoustic transmission of the respiratory system are presented. Continuous speech utterance is used as acoustic stimulation. The transmitted acoustic signal is recorded from various sites over the chest wall. The AR method analyzes the power spectral density function of the transmitted sound, which heavily depends on the microphone assembly and the utterance. The method was applied to a screening problem and was tested on a small database that consisted of 19 normal and five abnormal patients. Using the first five AR coefficients and the prediction error of an AR(10) model, as discriminating features, the system screened all abnormals. An ARMA method is suggested, which eliminates the dependence on microphone and utterance. In this method, the generalized least squares identification algorithm is used to estimate the ARMA transfer function of the respiratory system. The normal transfer function demonstrates a peak at the range of 130-250 Hz and sharp decrease in gain for higher frequencies. A pulmonary fibrotic patient demonstrated a peak at the same frequency range, a much higher gain in the high frequency range with an additional peak at about 700 Hz.

The nuclear pacemaker: is renewed interest warranted?

From 1973 through 1987, 155 radioisotope-powered "nuclear" pacemakers were implanted in 132 patients at the Newark Beth Israel Medical Center. The longevity of the first 15 devices, all of which were fixed-rate (VOO) pacemakers, was significantly better than that of 15 lithium-chemistry demand (VVI) pacemakers used as control devices (p = 0.0002). Of the entire cohort of 155 nuclear pacemakers, 136 were VVI devices and 19 were VOO units. The patients with VOO pacemakers needed reoperations more often than did those with VVI pacemakers, chiefly for mode change (p less than 0.001). Power-source failure was observed in only 1 case, but 47 nuclear pacemakers were removed for other reasons, including component malfunction (15 units), mode change (12 units), high pacing thresholds (8 units) and lead or connector problems (5 units). The actuarial survival at 15 years was 99% for power sources and 82% for the entire pacing systems (pulse generators plus leads). The frequency of malignancy was similar to that of the population at large and primary tumor sites were randomly distributed. Deaths most commonly were due to cardiac causes (68%). Thus, nuclear pacemakers are safe and reliable and their greater initial cost appears to be offset by their longevity and the resulting decrease in the frequency of reoperations. It is reasonable to suggest that further use be made of long-lasting nuclear power sources for modern pacemakers and other implantable rhythm-management devices.