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.