Interference of apex locator, pulp tester and diathermy on pacemaker function.

AIM: The purpose of this study was to evaluate the effects of three electronic apex locators (EAL), electric pulp tester (EPT) and diathermy on pacemaker function in vitro. MATERIALS AND METHODS: Three EALs: Root ZX (J. Morita Co., Tustin, CA, U.S.A.), Propex (Dentsply), Mini Apex locator (SybronEndo, Anaheim, CA, USA), EPT (Parkell pulp vitality tester Farmingdale, NY, USA) and Diathermy (Neomed 250 B) were tested for any interference with one pacemaker (A medtronic kappa KVDD901-serial number: PLE734632S). Directly connecting the pacemaker lead with the EAL/EPT/diathermy operating on a flat bench top, the telemetry wand was held directly over the pacemaker to monitor the pacing pattern for a period of 30 s. Pacemaker activity was continuously recorded on the telemetric programmer and electro gram (EGM) readings examined for pacer inhibition, noise reversion or inappropriate pacemaker pulses. RESULTS: All the three apex locators showed no pacing interference or background noise during its function or at rest. The EGM readings of EPT showed varying levels of background noise in between pacing however, this did not affect the normal pacing pattern and the pacing interval remained constant. EGM readings of diathermy showed an increase in the pacing interval (irregular pacing pattern) followed by complete inhibition of the pacing system. CONCLUSION: The tested EALs do not interfere with cardiac pacemaker function. The tested EPT showed varying levels of background noise but does not interfere with cardiac pacemaker function. Use of Diathermy interfered with the normal pacing, leading to complete inhibition of the pacing system.

Tenecteplase in the treatment of acute pulmonary thrombo-embolism.

This is a retrospective study documenting the use of tenecteplase in 41 cases of suspected or confirmed pulmonary embolism receiving in-hospital tenecteplase as per weight-adjusted dosing in addition to standard heparin and oral anticoagulant therapy. The presenting symptoms of dyspnoea, chest pain, hemoptysis and syncope were found in 40 (97.56%), 19 (46.34%), 6 (14.63%) and 9 (21.95%) patients, respectively. There was one case of mortality who was a 26 yrs old female of postpartum pulmonary thrombo-embolism with severe hypotension, cyanosis, bilateral crepitations in lungs and pulmonary hypertension. In the 40 survived patients, there was alleviation of dyspnoea and hemoptysis in all patients. Significant reduction in tachycardia (P < 0.0001) and increase in the oxygen saturation (SaO2) (P < 0.0001) were seen at discharge as compared to at the time of presentation. Eighteen patients had hypotension which recovered in all patients till the time of discharge (P < 0.0001). There was a significant reduction in right ventricular systolic pressure in all 18 patients who underwent 2-D echocardiography both before and after the tenecteplase therapy. Resolution of pulmonary embolism on CT pulmonary angiography was documented in only two patients. No bleeding events or any other adverse events were reported during this study. The present study suggests favourable efficacy of tenecteplase in patients with suspected or confirmed acute pulmonary embolism. Although no major adverse events were noted, a large prospective study on the use of tenecteplase in pulmonary embolism is suggested.

Cardiovascular responses to head-down-body-up postural exercise (Sarvangasana).

Sarvangasana (SVGN) is a head-down-body-up postural exercise in a 'negative g' condition. Though highly recommended as one of the three best of all the asanas it has not yet been studied for its very obvious effects on the cardiovascular (CV) functions. This paper reports the results of the first systematic investigation on SVGN employing echocardiographic analysis in eight healthy male subjects before and after a practice of this asana twice daily for two weeks. The resting heart rate (HR) and left ventricular end-diastolic volume (LVEDV) were significantly reduced (P < 0.02, P < 0.01 respectively) after practising this asana. A tendency toward a mild regression of the left ventricular mass was noticed, though it was not statistically significant. The CV responses to acute 45 degrees head-down tilt (HDT) in a tilt table was not altered after practising this asana. Also there was no orthostatic intolerance during the 3-5 min period of 70 degrees head-up tilt (HUT). These results strongly indicate that further studies of this asana performed for a longer period is most likely to yield very significant observations of applied value.

Pulmonary wedge aspiration cytology in the diagnosis of recurrent tumour embolism causing pulmonary arterial hypertension.

Recurrent subacute pulmonary embolism leading to pulmonary arterial hypertension is an uncommon presentation of malignancy. We describe one such patient who presented to us with features of pre-capillary pulmonary arterial hypertension. A novel yet simple technique, involving pulmonary wedge aspiration cytology, provided the tissue diagnosis of trophoblastic malignancy, thus enabling prompt institution of chemotherapy and consequent impressive clinical improvement. This technique appears to be a hitherto unreported indication for intravascular catheterisation in the diagnostic work up of pulmonary arterial hypertension.