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----- Original Message -----

From: " Kathi " <pureheart@...>

Sent: Friday, December 20, 2002 6:00 PM

Subject: TOXIC DISCOVERY ALERT

> TOXIC DISCOVERY ALERT

>

>

> _________________________________________

>

> FDA Public Health Notification:

> Diathermy Interactions with Implanted Leads and

> Implanted Systems with Leads

> (You are encouraged to copy and distribute this information)

>

> December 19, 2002

>

>

> Dear Colleague:

>

> This is to alert you to the risk of serious injury or death if patients

> with implanted electrical leads are exposed to diathermy treatments.

>

>

> BACKGROUND

>

>

> Adverse events

>

> FDA has received reports in which patients with implanted deep brain

> stimulators (DBS) died after receiving diathermy therapy. One patient

> received diathermy following oral surgery,

> the other for treatment of chronic scoliosis. In both cases, the

> interaction of the diathermy with the implanted device caused severe

> brain damage in the area where the lead electrodes

> were implanted.

>

> Types of diathermy affected

>

> There are three types of diathermy equipment used by physicians,

> dentists, physical therapists, chiropractors, sports therapists, and

> others: radio frequency (shortwave) diathermy,

> microwave diathermy and ultrasound diathermy. Shortwave and microwave

> diathermy, in both heating and non-heating modes, can result in serious

> injury or death to patients with

> implanted devices with leads. This kind of interaction is not expected

> with ultrasound diathermy. Electrocautery devices are not included in

> this notification.

>

>

> Medical devices affected

>

> Laboratory testing has shown that patients with any implanted metallic

> lead are at risk of serious injury when exposed to shortwave or

> microwave diathermy therapy. This is true even

> if the implanted device is not turned on, and even if the lead is no

> longer connected to an implanted system. Interaction of the diathermy

> energy with the implanted lead causes

> excessive heating in the tissue surrounding the lead electrodes.

> Insufficient testing has been done to determine whether there is a safe

> distance between the diathermy applicator and

> the implant system that might allow patients to be treated with

> diathermy without risk of injury.

>

>

> RECOMMENDATIONS

>

> Shortwave or microwave diathermy SHOULD NOT BE USED on patients who have

> ANY implanted metallic lead, or any implanted system that may contain a

> lead. Both the heating

> and non-heating modes of operation pose a risk of tissue destruction.

>

> If you are a physician who implants or monitors patients with leads or

> implanted systems with leads:

>

> - Explain to the patient what diathermy is, and stress that they should

> NOT receive shortwave or microwave diathermy therapy.

>

> If you are a health care professional who uses diathermy (shortwave or

> microwave) in your practice:

>

> - Be sure to ask the patient about possible implants before deciding to

> administer shortwave or microwave diathermy therapy. If the patient has

> an implanted lead or an implant

> containing a lead, diathermy therapy should not be used, even if the

> implant has been turned off. Examples of implanted systems that may

> contain a lead include cardiac pacemakers

> and defibrillators, cochlear implants, bone growth stimulators, deep

> brain stimulators, spinal cord stimulators, and other nerve stimulators.

>

> - Do not administer shortwave or microwave diathermy therapy to a

> patient who has had an implant in the past unless you are absolutely

> certain that the implant and all leads in their

> entirety have been removed. Note that leads are often left implanted

> after the implant is removed.

>

>

> Reporting adverse events to FDA

>

> The Safe Medical Devices Act of 1990 (SMDA) requires hospitals and other

> user facilities to report deaths and serious injuries associated with

> the use of medical devices. This means

> that if a patient death or serious injury can possibly be attributable

> to a diathermy device, or attributable to interactions of diathermy

> devices with any implanted device, you should

> follow the procedures established by your facility for mandatory

> reporting.

>

> If you have experienced problems with diathermy devices, or adverse

> events involving interactions of diathermy devices with any implanted

> device, you can report this directly to the

> manufacturer. Alternatively, you can report directly to MedWatch, the

> FDA?s voluntary reporting program. You may submit reports to MedWatch

> four ways: online to

> http://www.accessdata.fda.gov/scripts/medwatch/; by telephone at

> 1-800-FDA-1088; by FAX at 1-800-FDA-0178; or by mail to MedWatch, Food

> and Drug Administration, HF-2, 5600

> Fishers Lane, Rockville, MD 20857.

>

>

> Getting more information

>

> If you have questions regarding this letter, please contact n

> Kroen, Office of Surveillance and Biometrics (HFZ-510), 1350 Piccard

> Drive, Rockville, land, 20850, by fax at

> 301-594-2968, or by e-mail at phann@.... Additionally, a voice

> mail message may be left at 301-594-0650 and your call will be returned

> as soon as possible.

>

> All of the FDA medical device postmarket safety notifications can be

> found on the World Wide Web at http://www.fda.gov/cdrh/safety.html.

> Postmarket safety notifications can also be

> obtained through e-mail on the day they are released by subscribing to

> our list server. You may subscribe at

> http://list.nih.gov/archives/dev-alert.html.ÿ

>

>

> Sincerely yours,

>

>

> W. al, Jr., MD, MPH

> Director

> Center for Devices and Radiological Health

> Food and Drug Administration

>

> ----------

>

> Toxic Discovery

> Phone: (573) 445-0861

> Toll Free - 1-800-462-9106

> Fax: (573) 445-4700

> www.toxicdiscovery.com

> " Informed Consent Begins With Informed Individuals "

> _____________

>

> --

> " Whatever a person thinketh in his heart so is he. "

>

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