Neurosurgery

Neurosurgery is the surgical specialty that addresses disorders and diseases of the brain and nervous system, as well as the arteries of the neck. Neurosurgeons diagnose and treat brain tumors, stroke, brain aneurysms, traumatic brain injury, seizure disorders, spinal disorders and movement disorders. Some neurosurgeons specialize in specific areas of the nervous system such as the brain, spinal cord or peripheral nervous system, or specific areas such as pediatric neurology, seizure disorders, neuro-oncology or neurovascular disorders.

Advanced imaging techniques such as CT, MRI, PET and magnetoencephalography are essential tools for microsurgery that substantially enhance accuracy and result in better outcomes. Minimally invasive techniques such as endoscopic endonasal surgery and ventricular endoscopy reduce collateral damage and speed recovery. More recently, surgeons have begun to use functional MRI intraoperative as well.

Neurosurgical treatments for stroke entail removing blood clots caused by accidents or hypertension to restore blood flow to a blocked artery in the brain. When a patient can be treated immediately following the onset of symptoms, a neurosurgeon will generally administer tissue plasminogen activator (tPA), a medication that dissolves blood clots non-surgically. For patients who are not eligible for treatment with tPA, neurosurgeons may opt to remove or break up the clot via image-guided catheterization processes.

Preventative neurosurgical procedures for strokes include carotid endarterectomy, in which fatty plaques are removed from the carotid arteries, enabling blood flow to the brain. In carotid stenting, tiny wire mesh tubes are placed in the carotid artery to hold the artery open and ensure adequate blood supply.

Arteriovenous malformations (AVM), potentially life-threatening connections between arteries and veins in the brain, may be treated using procedures that block blood flow through embolization or radiosurgery. Depending on their location, brain tumors may be surgically removed or treated via radiosurgery as well.

Ventriculo-peritoneal and ventriculo-atrial shunting are surgical treatments for hydrocephaly, a condition in which cerebrospinal fluid fails to drain properly from the brain, putting pressure on delicate structures.

Seizures that cannot be controlled with medication may be treated through surgical removal of the locus of the abnormal electrical activity within the brain. A recently developed procedure entails insertion of a vagal nerve stimulator in the patient’s neck to control seizures.

Other conditions treated by neurosurgeons include spinal tumors, spinal disc herniation, traumatic injury of peripheral nerves and spinal stenosis.

Abbott Laboratories Medical Equipment

Abbott Laboratories is a global healthcare products company that is based in northern Illinois. Abbott develops, manufactures and sells diagnostic equipment as well as medical devices for vision care, diabetes care and treatment of vascular disorders.

Abbott Laboratories is a leading provider of immunoassays and blood screening equipment. Instruments and tests produced by its Core Laboratory Diagnostics unit are used in hospitals, clinics and laboratories to diagnose and monitor infectious diseases, cancer, diabetes and heart disease and to protect blood supplies in blood banks and hospitals.

The company’s point of care diagnostics equipment provides instant data inputs for patient care right at the bedside in real time based on a small blood sample from a finger-stick. Wireless capabilities enable remote consultation through easy sharing of test results. i-STAT systems provide information for routine diagnostics as well as diagnosis of cardiac conditions.

Highly sensitive molecular diagnostics are screening tests designed to ensure that every individual cancer patient receives the therapy or combination of therapies that will be most efficacious, based on the specific molecular structure of his or her disease. Abbott Laboratories currently offers molecular diagnostics for breast and lung cancers and is developing similar tests for additional types of cancer.

Abbott Laboratories equipment for treatment of vascular disorders include drug-eluting stents designed to establish and maintain blood flow in clogged arteries as well as bioresorbable vascular scaffolds, which are sold under the Absorb name. Additional vascular care products include mitral clips for repairing mitral valve leaks, carotid stents, guide wires, devices that protect against emboli and vessel closures.

For diabetes care, Abbott Laboratories offers fast, accurate and easy-to-use blood glucose monitors, including a recently introduced monitor that features an integrated meal-time insulin calculator. Blood glucose monitors are sold under the FreeStyle, Precision and Xceed brand names.

Abbott Laboratories is also active in the ophthalmic products market, with products ranging from consumer eye drops and lens solutions to professional LASIK surgery systems. The company markets phacoemulsification systems for sculpting and emulsifying cataracts as well as excimer and femtosecond laser systems for refractive surgery to correct myopia and astigmatism.

Used CT Equipment

In recent years, sales of used and refurbished CT equipment have increased steeply throughout the world. Historically, used and refurbished imaging equipment was purchased by medical facilities in third world countries and rural areas. In the mid-1990’s, with managed care perceived as a likely response to spiraling medical costs, demand increased in US urban areas as well as large US hospital chains began opting for used CT equipment.

A limited amount of relatively new CT equipment becomes available as top tier medical centers replace equipment in an effort to maintain a technology advantage over competitive health care facilities, and in order to provide physician-researchers with the cutting edge technology that they need to conduct novel studies. Larger quantities of used CT equipment has become available as medical centers and free-standing imaging centers have been shuttered or downscaled as a result of the economic downturn. Equipment from these centers is sold to raise funds for debt settlement and refurbished for resale.

On the demand side, medical centers in the US as well as around the world are seeking ways to maximize return on their medical equipment budgets. With used CT equipment generally available at half the cost of similar new equipment, purchasing used CT equipment is an ideal way to reduce the cost of providing important diagnostic services. The cost of a new CT can exceed a million dollars, while refurbished equipment may be sold for less than half the original price.

Used CT equipment is refurbished and offered for sale by major CT manufacturers such as GE and Siemens. A number of engineering service companies also refurbish the equipment for resale.

Equipment that is to be resold is inspected at the original site and de-installed. All performance records are examined for evidence of malfunctions. Only CTs for which replacement parts are available—and will continue to be available—are refurbished.

Once a CT has been determined to meet established criteria, it is shipped to a factory or workshop, where the used CT equipment is disassembled and thoroughly cleaned. Painted parts are touched up or repainted. Broken or worn parts are replaced with original replacement parts. System software is checked for bugs and updated to the most recent versions. Systems may be customized. Used CT equipment is tested thoroughly for safety and performance before being shipped to the purchaser’s site for installation.

New Developments in Urology Probes

Urology probes are used for treating a variety of disorders including prostate, renal and urinary tract cancers, and urinary and renal obstructions. They are also used for imaging the urinary tract.

Cryoablation probes are used to treat prostate cancer in a minimally invasive technique that has entered wider use in recent years. In cryoablation, an extremely small cryoprobe (2.4mm-.36 mm) and a thermoprobe are inserted through the perineum and are used to freeze the prostate gland in a controlled process that destroys the cancer at the molecular, cellular and tissue levels. The procedure is often used as a second tier treatment in cases where radiation treatment fails or when the cancer recurs following radiation. The freezing process is monitored via a transrectal ultrasound probe.

Various types of lithoscopy probes are used to break up and remove biliary and urethral stones. Electrohydraulic lithotripsy (EHL) probes are comprised of two electrodes, with insulation between them. A spark is generated at the end of the probe by activating an electric current between the electrodes, vaporizing a drop of fluid that is at the end of the probe. The cavitation bubble that results from vaporization of the fluid expands rapidly, creating shock waves that cause the stone to fragment. Each disposable EHL probe is used for just one patient.

Ultrasonic lithotripsy probes are positioned percutaneously via a rigid endoscope. The procedure differs from electrohydraulic lithotripsy in that the probe must form a straight channel through which ultrasound waves can reach the stone, since deflection results in significant decrease in power. Mechanical and ballistic lithotripsy probes are inserted via endoscope as well, and use pneumatically propelled projectiles to break up the calculi. In recent years, physicians have come to prefer laser-equipped lithotripsy probes that fragment stones effectively and result in fewer complications.

Urology probes are used in additional cystoscopy procedures such as viewing the inner surfaces of the urinary tract and treating a variety of urinary conditions via microsurgery.

In recent studies, optical coherence tomography (OCT) probes have been proven effective at imaging cross-sections of the upper urinary tract at resolutions of 10 to 20 µm. The probe was inserted through a cytoscope and urinary catheter. In the studies, physicians were able to distinguish between the different layers of the urinary tract and identify urothelial cancers in vivo.

High Field MRI

High field MRI’s use powerful magnetic fields to quickly generate extremely high-resolution images. Because high field MRI’s also scan very quickly, they are excellent for visualizing physiological processes in addition to structural tissue.

Early MRI’s were based on 0.35 and 0.5 Tesla magnets, which were quickly replaced by 1.5 Tesla magnets by the late 1980’s. Higher power magnets yield relatively lower signal-to-noise ratio, which in turn can translate into higher resolution imaging and/or reduced imaging time. By the 1990’s, advances in producing homogeneous magnetic fields and robust signal reception radiofrequency arrays, as well as mechanisms and procedures to ensure patient safety, led to the introduction of high field MRI’s based on 3.0 Tesla magnets, which offered significant improvements in image resolution. Ultra-high field MRI’s are now being introduced which use magnets of up to 7.0 Tesla.

Significantly, high field MRI facilitate new functional MRI techniques which use blood-oxygen level contrast, angiography and other techniques to map muscle oxygenation and muscle function. Ultra-high field MRI also has relatively greater sensitivity to low-gamma nuclei, enabling assessment of sodium physiology and phosphorus metabolites.

Ultra-high field MRI enables studies of human joints such as knees and wrists, since it produces high resolution images of cartilage, which cannot be imaged by conventional MRI due to its small size. Evaluation of joints is further enhanced by ultra-high field MRI’s ability to evaluate cartilage biochemistry via sodium MRI and gadolinium-enhanced MRI. Bone micro-architecture studies also generate metrics for structural alterations associated with bone disorders such as osteoporosis. Sodium MRI supports physiological assessment of muscle as well by providing information about the sodium-potassium pump and ion balance.

High field and ultra-high field MRI offer great promise in the field of brain imaging. A 3.0 Tesla MRI’s provide spatial resolution as low as 200 µm, enabling imaging of blood flow within the vessels of the brain. At 7.0 Tesla, resolution of 50 µm may allow detection of senile plaques such as those associated with early stages of Alzheimer’s disease. At very high magnetic fields, MRI’s could be used to detect biochemical reactions as well as very small lesions, facilitating diagnosis and early treatment of early stage cancers, myocardial infarctions, diabetes and other metabolic disorders.

Refurbished Medical Equipment

In recent years, a large aftermarket has emerged for medical devices and equipment that have been restored to safety and efficacy. The equipment is refurbished through a process of repairing worn and broken parts or replacing them with original parts, and updating software and electronics. Because no product specifications are altered during the refurbishment process, as for remanufactured products, refurbished products may be sold worldwide without obtaining special approvals. This has created a burgeoning international market in medical equipment and devices, distinct from the market in used—and unrestored—products, and remanufactured products.

The market is expanding at an annual rate of almost 8% annually. By 2017, annual sales of refurbished medical equipment are expected to reach almost $8.5 billion worldwide. Both OEM producers of medical devices and equipment and third party vendors are active in the market. Refurbished equipment is widely used in both developed countries and emerging economies, driven by pressure to contain healthcare costs and environmental concerns. An estimated one third of CT scanners in the US are refurbished.

The refurbishing process generally starts with inspection and de-installation at the site of the original equipment owner. The condition of the equipment is assessed and its performance history is reviewed. If the equipment meets the refurbishing company’s criteria, and if spare parts are available (and will remain available for at least a few more years), the equipment is de-installed by qualified technicians and shipped to a factory, in the case of OEM refurbishers, or to an engineering workshop.

At the factory or workshop, the equipment is fully disassembled, cleaned and disinfected. Parts are painted or their finishes are otherwise restored. All components are checked for wear and operability, and worn or nonfunctioning elements are replaced with original parts. All software and systems are updated. In many cases, systems will be customized to meet customer requirements. Finally, the equipment undergoes testing to ensure that it performs safely and accurately.

Once the restoration process is complete, the equipment is shipped to the purchaser’s site and installed. It undergoes an on-site testing process and, when necessary, safety certification. Some vendors provide training in the use of the new system. In most cases, refurbished equipment is sold under warranty and with a service contract.

An extremely wide range of medical equipment and devices are sold as refurbished, including diagnostic and imaging equipment, surgical equipment, monitoring devices and biotechnology instruments.

Lasers

Lasers are devices that amplify light by stimulating photon emission. By minimizing diffraction, lasers create a very narrowly focused pencil beam of highly coherent, high intensity light. The beam can be directed with great precision to any spot, where it heats the target area to the desired degree.

Lasers may use gas, chemicals or a glass rod doped with ions to generate the energy state required to stimulate photon emission. The various types of lasers produce light with different wavelengths and degrees of coherence, giving users the ability to choose the ideal tool for each application.

Chemical lasers provide very high levels of power and are generally used for military and industrial applications. Gas lasers vary widely in power and function based on which gas is used to power them. Helium neon lasers are used in optical labs and research, while CO2 lasers are for cutting and welding in industrial applications. Other gas lasers are used by hobbyists and for spectroscopy. Specialized gas lasers called excimer lasers are used for LASIK eye surgery as well as for semiconductor lithography.

Solid state lasers, which create photon-generating energy states by doping glass rods with various ions, are used for different purposes depending on which ions are used and the power and spectrum of the resulting beams. Neodymium lasers are used for cutting and welding metals as well as for spectroscopy. Very high power solid state lasers are used in optical fiber surgical devices. Extremely short pulses are directed through the optical fibers and used to resurface joints, vaporize cancers and dissolve kidney and gall stones.

Other specialized types of lasers that are used for diagnosing and treating medical conditions include diode lasers, free electron lasers, optical parametric oscillators and diode lasers. Used for surgical procedures, lasers provide greater precision than even the smallest scalpel, enabling surrounding areas to remain unscathed. Laser procedures result in less blood loss, less discomfort and less scarring than traditional procedures, and reduce the incidence of infection. Lasers are also used in medical imaging, hair and tattoo removal and angioplasty.

Ultrasound

Ultrasound imaging utilizes high frequency sound pressure waves to detect and map anatomical structures within the body. The frequencies of the waves, generally between 2 and 18 MHz, are too high to be detected by the human ear.

Boston Scientific Medical Equipment

Boston Scientific develops and markets a wide range of medical devices and technologies, with a particular focus on developing technologies that are less invasive than standard solutions and therefore less traumatic, less risky, less costly and require less aftercare.

The company’s primary areas of focus include interventional cardiology, electrophysiology, endoscopy, cardiac rhythm management, women’s health and urology, neuromodulation, and peripheral interventions.

In the field of cardiac rhythm management, Boston Scientific product offerings include a range of devices that prevent and treat rhythm disorders and arrhythmias, as well as heart failure and cardiac arrest. The company’s products include pacemakers, implantable defibrillators, resynchronization therapy devices and remote monitoring solutions.

Boston Scientific electrophysiology products enable physicians to accurately diagnose and treat cardiac arrhythmias. The line includes devices for cardiac ablation, mapping and catheritization which integrate advanced technologies such as cryogenics and radiofrequency energy.

The company’s endoscopy line focuses on diagnosis and treatment of diseases and conditions of the respiratory and digestive systems, such as tumors, pulmonary and gastrointestinal diseases, renal disease and abscesses. Solutions include stents, biliary and urinary drainage, enteral feeding systems, hemostasis, cholangioscopy and balloon dilation.

Interventional cardiology is an area of particular specialization for Boston Scientific, which has been a leader in developing and marketing innovative less-invasive technologies in the field. Solutions for diagnosing and treating cardiovascular diseases such as coronary artery disease and myocardial infarction include drug eluting and bare metal stents, catheters, balloons, guide wires and coronary intravascular ultrasound.

The company has also developed stents and balloon catheters that are used to relieve blockages and prevent embolism formation in carotid, renal and lower extremity arteries.

Boston Scientific neuromodulation therapies focus on chronic neuropathic pain management through the use of microelectronic stimulators that are implanted in the spinal cord. The company is currently testing deep brain stimulation systems for treatment of Parkinson’s disease.

Urology and gynecological disorders including stress incontinence, kidney and bladder stones, benign prostatic hyperplasia, and excessive uterine bleeding can be addressed by Boston Scientific endometrial ablation, HoLAP, lithotripsy and urethral bulking and sling products.

Boston Scientific is active in markets throughout the world. As part of an effort to expand its presence in the Asia Pacific region, it is currently constructing a state-of-the-art manufacturing and healthcare provider training facility in China.

Infusion Pumps

Infusion pumps are generally used in hospitals, healthcare facilities and in home care settings to intravenously deliver controlled amounts of fluids containing nutrients and medications into patients’ bodies. They are designed to safely administer chemotherapy, analgesics and antibiotics.

Endoscopy

Endoscopy is a procedure in which a physician examines a patient’s digestive tract from within. During an endoscopy, an endoscope—an instrument that features a minute camera and a light mounted on a long, hollow, flexible tube—is inserted into a patient’s lower or upper digestive tracts.

CT Scanner Parts

A CT scanner is a complex device that obtains large numbers of X-ray images from every point around numerous “slices” of a patient’s body. Complex algorithms are used to integrate the numerous images from the different vantage points into complete cross-sectional images of the patient’s body.

Orthopedic MRI (Stand Up MRI)

Orthopedic magnetic resonance imaging (MRI) is a valuable tool that generates accurate, clear pictures of the soft tissue that surrounds bones and joints. MRIs enable physicians to clearly see tears and injuries to muscles, ligaments and blood vessels.