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3D Printed Organs

An artificial prostate fitted with a soft sensor
An artificial prostate fitted with a soft sensor(Credit: McAlpine Research Group)

An international team of researchers has used 3D-printing technology to produce individually-tailored model organs. These dummy organs could one day improve your chances of surviving surgery, by allowing doctors to plan and practice a lifesaving procedure on a realistic replica before putting you to the scalpel.

Surgery is often a matter of life or death. The ability to practice a procedure outside of the operating room on an artificial human, or at least the relevant organ of a patient, can help to prepare a doctor for surgery, and so increase the chances of a patient surviving the procedure. read more

Xbox Surgery

THE surgeon enters the operating room, covered in sterile blue scrubs. Machines beep and hiss. Nurses wait, tools at the ready: scalpel, forceps, bandage, Xbox… Xbox?

A surgeon at Guy’s and St Thomas’ hospital in London began trials of a new device that uses an Xbox Kinect camera to sense body position. Just by waving his arms the surgeon can consult and sift through medical images, such as CT scans or real-time X-rays, while in the middle of an operation.

Maintaining a sterile environment in the operating room is paramount, but scrubbing in and out to scroll through scan images mid-operation can be time-consuming and break a surgeon’s concentration.

Depending on the type of surgery, a surgeon will stop and consult medical images anywhere from once an hour to every few minutes. To avoid leaving the table, many surgeons rely on assistants to manipulate the computer for them, a distracting and sometimes frustrating process.

“Up until now, I’d been calling out across the room to one of our technical assistants, asking them to manipulate the image, rotate one way, rotate the other, pan up, pan down, zoom in, zoom out,” says Tom Carrell, a consultant vascular surgeon at Guy’s and St Thomas’, who led the operation on May 8th to repair an aneurism in a patient’s aorta. With the Kinect, he says, “I had very intuitive control”.

Carrell used the system to look at a 3D model of a section of the abdominal aorta, captured on a CT scan. This was projected on to a 2D live image-feed of the operation site, taken with a fluoroscopic X-ray camera. So Carrell could see what was happening inside the patient, as well as using the 3D model to help navigate the twists, turns and branches of the aorta. He says he consulted the system four or five times during the 90-minute operation.

Being able to check the images easily also helps surgeons maintain their concentration throughout the procedure. “You’re just doing all of this stuff non-verbally and it just happens much more quickly. You’re maintaining the flow of what’s going on,” says Carrell.

But manipulating a “touchless” medical image-viewer in a room filled with surgeons, nurses, machines, trays, cables and lights poses challenges of its own.

“You usually think of Kinect in a game-like scenario where you can jump around and move your hands as wide as possible, but surgeons are not allowed to reach such a large area,” says Gerardo Gonzalez of Microsoft Research in Cambridge, UK, who helped develop the system in conjunction with surgeons from Guy’s and St Thomas’ and King’s College London.

So Gonzalez and colleagues developed a set of gestures that a surgeon can perform in a constrained space, while standing at the operating table. For the most common actions – rotating the 3D model or placing a marker on the image – the team designed one-handed gestures that combine with voice commands, leaving the other hand free for operating. To position a marker, for example, the surgeon simply points at the image to activate a cursor and says, “place marker”. Other functions, such as panning or zooming, require two hands.

Despite initial misgivings, Carrell is eager to continue working with the system. “I thought this was going to be a lot more awkward to start off with, but I was very pleased with the way it went today.”

Attribution: New Scientist

Hand to Mouth has New Meaning

A paralyzed man has regained the use of his hand after he had a pioneering operation to bypass damage to his spinal cord.

The 71-year-old patient injured the lowest bone in his neck in a car crash in June 2008.
The damage to the C7 vertebra left him without the use of his legs and only limited shoulder, elbow and wrist function.

He also lost the use of his hand because while the nerve circuit in his hand was intact, the connection between his brain and digits had been lost.

Surgeons at Washington University School of Medicine in St Louis restored this link by rerouting working nerves in his upper arm.’

The patient can now pinch his thumb and index fingers together using nerves that once told his brain to bend at the elbow.

Senior researcher Dr Ida K Fox said, “This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is. Instead, we go out to where we know things work – in this case the elbow – so that we can borrow nerves there and reroute them to give hand function.”

The successful operation means the patient can now feed himself and even write.
“Many times these patients say they would like to be able to do very simple things,” Dr Fox said.

“If we can restore the ability to pinch, between thumb and index finger, it can return some very basic independence.”

The surgery was developed and performed by Dr Susan E. Mackinnon. Specializing in injuries to peripheral nerves, she has pioneered similar surgeries to return function to injured arms and legs.

She said hand function was not restored right away and that the patient had to undergo intensive physical therapy to retrain the brain to understand how the role of the nerves had changed.

Dr Mackinnon said another patient with a similar injury could be treated at any time as their case study received the surgery two years after his accident.
She said nerves run out from the spinal cord ‘like spaghetti’ to the tips of the fingers and toes.

Nerves remained healthy as they were still connected to the spinal cord, however the nerves could no longer ‘talk’ to the brain because the spinal cord injury blocks them.
To detour around the block in this patient’s C7 spinal cord injury and return hand function below the level of the injury, Mackinnon operated in the upper arms.

There, the working nerves that connect above the injury and the non-working nerves that connect below the injury run parallel to each other, making it possible to tap into a functional nerve and direct those signals to a non-functional neighbor.

In this case, Mackinnon took a non-working nerve that controls the ability to pinch and plugged it into a working nerve that drives one of two muscles that flex the elbow.
After the surgery, the bicep still flexes the elbow, but a second muscle, called the brachialis, that used to also provide elbow flexion, now bends the thumb and index finger.

“This is not a particularly expensive or overly complex surgery,” Dr Mackinnon said. “It’s not a hand or a face transplant, for example. It’s something we would like other surgeons around the country to do.”

Attribution: Claire Bates

A Cure for Prostate Cancer?

A new treatment for prostate cancer can rid the disease from nine in ten men without debilitating side effects, a study has found, leading to new hope for tens of thousands of men.

It is hoped the new treatment, which involves heating only the tumours with a highly focused ultrasound, will mean men can be treated without an overnight stay in hospital and avoiding the distressing side effects associated with current therapies.

A study has found that focal HIFU, high-intensity focused ultrasound, provides the ‘perfect’ outcome of no major side effects and free of cancer 12 months after treatment, in nine out of ten cases.

Traditional surgery or radiotherapy can only provide the perfect outcome in half of cases currently.

Experts have said the results are ‘very encouraging’ and were a ‘paradigm’ shift in treatment of the disease.

It is hoped that large scale trials can now begin so the treatment could be offered routinely on the NHS within five years.

The National Institute for Health and Clinical Excellence (NICE) will say in new guidance next week that the treatment is safe and effective and larger scale trials should go ahead.

A larger trial is already recruiting patients and men interested in the treatment should speak to their cancer doctor or GP about being referrred, experts said.

Prostate cancer is the most common cancer in men with more than 37,000 diagnoses each year and approximately 10,000 deaths.

Current treatments include surgery to remove the whole prostate or radiotherapy. Both of which can effectively treat the cancer but often cause side effects such as incontinence and impotence.

However in many men, prostate cancer will not progress to a life threatening disease meaning that radical treatment,  risk side effects unnecessarily. For this reason,  research is now focused on reducing side effects.

Focal HIFU involves careful selection of tumors, as small as a grain of rice, within the prostate gland and targeting them with highly focused ultrasound to heat them and destroy them.

The advantage over previous HIFU and other treatments is that damage to surrounding tissue is minimized, meaning there are far fewer side effects.

In the study published in the journal Lancet Oncology, 41 men were treated with focal HIFU. After 12 months, none were incontinent and one in ten suffered impotence.

The majority, 95 per cent, were free of cancer after 12 months.

Dr Hashim Ahmed, who led the study at University College London Hospitals NHS Foundation Trust andUniversity College London, said: “This changes the paradigm. By focusing just on the areas of cancer we reduce the collateral damage to surrounding tissue.

“Our results are very encouraging. We’re optimistic that men diagnosed with prostate cancer may soon be able to undergo a day case surgical procedure, which can be safely repeated once or twice, to treat their condition with very few side-effects. That could mean a significant improvement in their quality of life.

“This study provides the proof-of-concept we need to develop a much larger trial to look at whether focal therapy is as effective as the current standard treatment in protecting the health of the men treated for prostate cancer in the medium and long term.”

 Ahmed said after NICE guidance is issued next week, he expected other doctors to consider using the treatment.

He said: “These results will encourage more physicians to look at it more carefully. If men are interested in this concept they should speak to their cancer doctror or their GP.”

“The next step is a large scale randomized controlled trial. This needs to be evaluated in a timly way so men can benefit.”

The research program is led by Professor Mark Emberton, of UCL and UCLH. He said: “Focal therapy offers harm reduction – it is a strategy that attempts to redress the balance of harms and benefits by offering men who place high utility on genito-urinary function an alternative to standard care.

“In fact, the concept is not new – tissue preserving strategies have been used successfully in all other solid organ cancers such as breast cancer by offering women a lumpectomy rather than mastectomy.”

Professor Gillies McKenna, director of the Medical Research Council and Cancer Research UK Gray Institute for Radiation Oncology and Biology, said: “Clinical trials, like this one supported by the MRC, are a fantastic tool for telling us whether experimental new treatments are likely to be effective in the clinic.”

“If these promising results can be confirmed in a randomized controlled trial, focal therapy could soon become a reasonable treatment choice for prostate cancer alongside other proven effective therapies.”

The research was funded by the MRC, the Pelican Cancer Foundation and St Peter’s Trust.

Jacqui Graves, Interim Head of Healthcare at Macmillan Cancer Support, said: “We welcome any research that shows early signs of improving the outcomes of treatment for prostate cancer patients.

“Significant reduction in the likelihood of common side effects, such as incontinence, will enable men to recover better and go on to lead good quality lives. We hope that a larger trial will be supported to ensure that the UK achieves the best outcomes for men affected by prostate cancer.”

Owen Sharp, Chief Executive of The Prostate Cancer Charity said: “We welcome the development of any prostate cancer treatment which limits the possibility of damaging side effects such as incontinence and impotence. These early results certainly indicate that focal HIFU has the potential to achieve this in the future.

“However, we need to remember that this treatment was given to fewer than 50 men, without follow up over a sustained period of time. We look forward to the results of further trials, which we hope will provide a clearer idea of whether this treatment can control cancer in the long term whilst ridding men of the fear that treating their cancer might mean losing their quality of life.”

Attribution: Daily Telegraph

Robo Surgeon

Doctors in the future might tell patients, ‘I’m afraid this is going to require surgery’ – then hand a pill that will do the surgery from inside the body.

A breakthrough at Stanford has created a Fantastic Voyage-style vehicle that can ‘swim’ through a patient’s veins, powered wirelessly by electromagnetic waves from doctors from outside.

Previous prototypes have been hampered by large batteries – but the new machine is around the size of a grain of rice.

The device could deliver drugs, perform surgery, or just take on ‘reconnaissance missions’ which would otherwise require invasive endoscope treatments.

The current prototype chip is only three millimeters wide and four millimeters long.

This week, at the International Solid-State Circuits Conference, Professor Ada Poon demonstrated a tiny, wirelessly powered, self-propelled medical device capable of controlled motion through blood.

‘Such devices could revolutionize medical technology,’ said Poon. ‘Applications include everything from diagnostics to minimally invasive surgeries.’

Poon’s most recent creation, could travel through the bloodstream to deliver drugs, perform analyses, and perhaps even zap blood clots or remove plaque from sclerotic arteries.

The idea of implantable medical devices is not new, but most of today’s implements are challenged by the size of their batteries, which are large and heavy and must be replaced periodically. Fully half the volume of most of these devices is consumed by battery.

‘While we have gotten very good at shrinking electronic and mechanical components of implants, energy storage has lagged in the move to miniaturize,’ said co-author Teresa Meng, a professor of electrical engineering and computer science. ‘This hinders us in where we can place implants within the body and also creates the risk of corrosion or broken wires, not to mention replacing aging batteries.’

Poon’s devices are different. They consist of a radio transmitter outside the body sending signals inside the body to an independent device that picks up the signal with an antenna of coiled wire.

The transmitter and the antennae are magnetically coupled such that any change in current flow in the transmitter produces a voltage in the other wire – or, more accurately, it induces a voltage.

The power is transferred wirelessly. It can be used to run electronics on the device and propel it through the bloodstream.

Attribution: By Rob Waugh

Don’t Tell My Kids

Playing video games could improve the vision of people born with cataracts, according to new research.

Surgery and contact lenses do not always work – and people experience visual difficulties into adulthood.

However, some of these effects can be reversed if the individual follows a short course of ‘game therapy’.

Doctor Maurer, of McMaster University in Canada, said: “After playing an action video game for just 40 hours over four weeks, the patients were better at seeing small print, the direction of moving dots, and the identity of faces.”

Psychologist Daphne Maurer has researched how vision develops in individuals born with cataracts in both eyes.

Previous research found that a 40-hour ‘course’ of video gaming could be used to treat ‘lazy eye’ or amblyopia, a brain disorder in which the vision in one eye fails to develop properly.

‘Those improvements tell us that the adult brain is still plastic enough to be trained to overcome sensory deficiencies,’ says Maurer.

Dr Maurer is internationally known for her work on “synaesthetes” – a condition that makes people’s brains link different senses.

Dr Maurer is due to present her findings at the American Association for the Advancement of Science in Vancouver, in a session called The Effects of Early Experience on Lifelong Functioning: Commitment and Resilience.

Attribution: Daily Mail