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Hurwitz, B. J., Zion, M. M., and Promund Obel, I. W. (1974).Thorax, 29, 678-684. Myocardial perforation by flexible Elema endocardial pacing catheters. Myocardial perforation as a complication of permanent endocardial pacing with flexible Elema catheters is described in nine patients. In eight patients pacing failed, but there were no other serious ill-effects. Diaphragmatic pacing occurred in five patients. Radiological evidence of movement, either posteriorly and/or laterally, of the electrode tip was detected in five patients. In only two of them was the electrode seen to be definitely extracardiac in position. A change in the pacing wave form aided the diagnosis in two patients. In a further two patients electrode tip electrocardiograms helped to confirm the diagnosis where, upon withdrawal of the perforating electrode, small Q waves disappeared, RS complexes enlarged, and the ST segments became more elevated, with deeply inverted T waves. Withdrawal and repositioning of the electrode catheters was performed in seven patients. In one, a new catheter was inserted, and in another, where uninterrupted cardiac pacing was accompanied by intermittent diaphragmatic pacing, the pacing system was left unaltered. The follow-up is from six months to four and a half years with one late death apparently unrelated to pacing failure.

Being stimulated by her performance, which introduced me to something entirely new, I searched the Internet, including Ruti's own web site at www.rutihai.com and learned that this form of therapy was introduced by Dr. Madan Kataria, a family practitioner from Mumbai in India. He was also a practitioner of Yoga and combined this with laughter, so that the technique is now referred to as Laughter Yoga. This is practiced in all parts of the world with Ruti being a prominent practitioner in Israel. Laughter Yoga improves health, increases well being and promotes desire for peace in the world through personal transformation. It is non-religious, non-sectarian and non- political. Laughter Yoga sessions last 20 to 30 minutes and may be adapted to suit the needs, abilities and motivations of a group participating.

Prior to commencing studies for the medical profession, one has to have completed courses in mathematics and physical science. In the first years of study at university, courses in physics and chemistry, followed by physiology and biochemistry further point to the fact that medical practitioners need to have a good basic knowledge of science. When one enters the clinical years of study, one learns that while the basis for our profession is scientific, the practice of medicine is, in fact, an art. Those who do not wish to participate in this art take further studies in physiology or other basic sciences, and embark on careers of pure research. We in the medical profession have wondered at the popularity of what is today known as \"alternative\" or \"complementary\" medicine. While some forms have been accepted by the profession as being physically beneficial, even if a physiological explanation is not apparent, many are well-accepted by the public even though claims of cures are so often exaggerated and unconfirmed.

ON our first visit to Israel in 1960, we were struck by the failure of people to stand in line when waiting to deal with a clerk, purchase tickets, get on a bus or in many other situations. Since our aliya in 1978, we have noted the efforts by various organizations to persuade the public of the need to stand in line. Thus, line barriers have been positioned in places such as banks and post offices and machines often dispense numbers so that people can wait their turn in an orderly manner. Of course, everyone has had the experience of reaching the front of a line and being approached by someone who hasn't waited at all, but \"just has a question.\" A variation is \"I only need to have a form signed,\" even though completion of the form could be a lengthy procedure. Yet another variation is the person shouting out a question to a clerk even though the the clerk is dealing with another person at the time. Amazingly, the clerk usually answers the question and further follow-up questions politely, and does not apologize to the person originally being dealt with.

Sir, - The \"sudden\" spread of the Klabsiella killer- microbe is frightful, but not surprising; it's just one in the series of crises in our chronically diseased health system (\"Olmert seeks urgent cure for ailing hospitals,\" March 9). The media can't be blamed, for it is constantly informing us about our preventive medicine (practically nonexistent) and our hospitals (some of the most dangerous places to be in). Sir, - Re \"Sadat's nephew calls for review of peace treaty with Israel\" (March 11): Anwar Esmat Sadat, nephew of the late Egyptian president, has enlightened even the most naive among us. Whether he is trying to advance his own political career or appeal to the Egyptian \"street,\" his words should be taken at face value and as a benchmark in future diplomatic dealings with the Palestinians and the rest of the Arab world. Sir, - I admire Morton Klein and the ZOA's loyalty to and support of Israel, but am disappointed they have called for a boycott of products made and sold by Coca-Cola in order to help a family obtain financial redress from the company (\"ZOA calls for boycott against Coca-Cola as Egyptian restitution case drags on,\" March 11).

Sir, - The Jerusalem Post is increasingly irresponsible in contributing to the dilution of the horror and opprobrium that should be attached to the word \"terrorist (\"Soldiers kill UN worker, mistaking him for terrorist,\" November 24). Terrorism is the use of violence against civilians for political purposes. The circumstances described in the article involved a gunfight between IDF members and Palestinian gunmen as the IDF sought to capture a member of Islamic Jihad, Abdullah Naji Wahash. At times members of Islamic Jihad might be acting as terrorists, but not when they have military rather than civilian targets. Whatever the IDF might have mistaken the UN worker for, it wasn't a terrorist, for one cannot be a terrorist in a fight between armed combatants. Sir, - The BBC and CNN constantly refer to terrorists as \"militants.\" When I objected to such usage by the BBC following the latest terrorist attack in Jerusalem, I received this reply: \"The terms used on our news reports are carefully considered by our experienced journalists... we feel that the... words that we use on our reports are correct.\"

Sir, - Thank you for Saul Singer's wonderful piece in The Post's August 4 edition (\"Fighting Goliath\"). I have wondered for some time if there is anybody who really gets what is happening now because I have read all sorts of trash written by supposedly knowledgeable people. Unfortunately, most of them just criticize the government of Israel for the manner it handled the recent war. Ironically, these folks did not offer any solutions. Sir, - The panegyric about \"Jewtopia\" by [BRYAN FOGEL] and [SAM WOLFSON] was surely written in jest, for the examples of humor in both the skit and the book are about as funny, or witty, as the scrawled graffiti in men's rooms, and as juvenile. I find more to laugh at in the dirges recited on Tisha Be'av, for at least they foresee a happy ending. Sir, - As an Jewish ex-East Ender (1925-51), I was pleased to read about Clive Bettington's interest in my \"home town.\" Readers may be interested to explore further the history of the East End by logging on to Philip Lachman's Web site \"Jewish East End of London Photo Gallery\" (www.olamgadol.pwp.blueyonder.co.uk). There they can read about my Jewish Alma Mater, that great seat of Jewish learning, Redman's Road Talmud Torah, as well as other Jewish institutions of the past, including synagogues, Yiddish theater, settlements, Jews' Free School and, of course, Grodzinsky's Bakery.

Sir, - The state comptroller's report notes with concern the increase in illegally-built structures in Silwan, and criticizes the Jerusalem Municipality for \"lax enforcement\" (\"State comptroller criticizes municipality for illegal structure increase in Arab Silwan neighborhood,\" October 14). Sir, - In his criticism of Prime Minister Binyamin Netanyahu's demand that the Palestinians recognize Israel as the Jewish state, Larry Derfner states: \"The Palestinians should not be asked to do that, anymore than Israel should be asked to recognize the US, Canada, Britain, France and other countries of the Jewish Diaspora as Christian states\" (\"Any more doubts about Bibi?,\" October 14). In the United States secular Jews who readily acknowledge that they are Jews are satisfied to get around the paradox of their non-practice by seeing themselves as members of an American \"ethnic group.\"