Pacing systems documentation

Neither restrictive nor malabsorption is the aim of gastric pacing systems. Laparascopically, a bipolar electrode is attached 3 cm distally to the oesoph-agogastric junction under endoscopic control. The electrode is connected to a pacemaker which constantly stimulates the fundus. The mechanism of effect remains unclear but a weight loss of 32%-22% is documented (Miller et al. 2002). 

The system of just-in-time production, in which inventory buffers are kept to a minimum, does, in fact, increase the cost of aeddents to the firm. This logic does not apply to chronic health problems, however, and Wokutch documents the reluctance of Japanese firms to address the long-term consequences of its high-paced, high-stress production system - particularly cumulative trauma disorders. 

Shonld a complete obstrnction between the superior vena cava and right atrium be documented, it is likely that the only reasonable approach for pacing will be an epicardial system, although there is at least one report of the use of the transhepatic approach for placement of a permanent pacing lead in such a patient (43). However, if there is stenosis without complete obstruction, one may consider balloon dilation with or without placement of an expandable stent (44). If a stent is placed, one should not cross the site immediately with a pacemaker lead becanse of the chance of dislodging the stent. If a stent is not placed, one shonld still wait nntil the area has healed to avoid the possibility of disrnpting an area with a fresh intimal tear. 

Within the last few years the need for documentation has increased with the complexity of the broadcast systems. Fortunately, the power of documentation tools has kept pace. 

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