Tools of the Trade: Adjunctive Tools for Lesion Crossing in Critical Limb Ischemia

Critical limb ischemia (CLI) due to obstructive atherosclerosis causes pain and tissue damage and may result in amputation and death. Revascularization saves the limbs and lives of patients with CLI. This review addresses adjunctive tools for lesion crossing, including mechanical atherectomy, laser atherectomy, crossing devices, and luminal reentry devices. Mechanical atherectomy devices are designed to excise atheroma, often heavily calcified, thereby preparing a channel for further intervention. Mechanisms (and devices) include directional (SilverHawk™, TurboHawk™, RockHawk™), rotational (Jetstream™, Pheonix™), and orbital (Diamondback 360°™, Predator 360°™, Stealth 360°™) atherectomy. A laser atherectomy device (Turbo Elite™) vaporizes atheroma by heating tissues with ultraviolet light. Crossing devices specifically designed for chronic total occlusions either navigate a vessel's true lumen or guide a controlled subintimal course with reentry into the distal true lumen. Crossing devices include Crosser® Catheter, Wildcat™, Ocelot™, Kittycat™, TruePath™, Viance™, Frontrunner™, TOTAL across™, and PowerWire™. When a guidewire or crossing device traverses a lesion via a subintimal course, a luminal reentry device may facilitate deployment of the guidewire in the distal vessel lumen. Reentry devices include Outback LTD™, Offroad™, Pioneer Plus™, and Enteer™.

3D Laparoscopic Monitors

Minimally invasive surgery (MIS) is a relatively new surgery comprising various procedures performed with special miniaturized instruments and imaging reproduction systems. Technological advances have made MIS an efficient, safe, and applicable tool for pediatric surgeons with unquestionable advantages. The recent introduction of three-dimensional (3D) high definition systems has been advocated in order to overcome some of the problems related to standard MIS visual limitations. This short paper recapitulates the necessity to minimize MIS visualization limitations and reports the characteristics of new laparoscopic 3D systems.

Stem Cells: The Future of Personalised Medicine?

After hitting the headlines in the 1960s, stem cell therapy has been the subject of great optimism in the treatment of many conditions. Discoveries of new procurement methods for various stem cells has allowed the technology and research to progress to a stage where real therapeutic alternatives are potentially viable. In order to determine the direction to move forward, it is first important to analyse the data that has been collected across well researched stem cell types (Embryonic Stem cells, Induced pluripotent stem cells, Haematopoetic stem cells and Mesenchymal stem cells) as well as emerging stem cell types (Very-small-embryonic-like stem cells, Spermatogonial stem cells and Parthenogenetic stem cells). Whilst by no means conclusive, the data does support the optimism surrounding these cells. Whilst stem cells may be embraced as the future of personalised medicine, following these pilot trials, research needs to become more focussed to allow advancement.

Clinical Performance of a Novel Portable epoc™ Analyzer for Arterial Blood Gas and Electrolyte Testing in Operating Rooms

Background A new blood gas analyzer (epoc™, Epocal Inc.) has recently been developed for the ambulatory monitoring of respiration and electrolyte balance. However, the accuracy of this instrument has not been fully elucidated. The present study compares the performance of the epoc™ analyzer and a conventional bench-top analyzer in operating rooms. Materials and Methods Fifty blood samples were collected from anesthetized surgical patients and three samples were collected from volunteers into syringes containing lithium heparin. pH, pCO2, pO2, Na+, K+ Ca2+, glucose, lactate and hemoglobin levels were measured using both the epoc™ and calibrated ABL700™ analyzers (Radiometer). Data were statistically analyzed using Pearson correlation coefficients and Bland-Altman plots. Results Results showed excellent agreement between the values measured using the epoc™ analyzer and those obtained using the ABL700™ analyzer, except for Na+. Conclusions The epoc™ analyzer is useful in clinical settings, including operating rooms.

Pedometer for Running Activity Using Accelerometer Sensors on the Wrist

The Nokia Wrist–Attached Sensor Platform (NWSP) was developed at the Nokia Research Center during the NUADU project to facilitate research and demonstrations of use cases of wearable wireless sensors. A wrist–worn pedometer application was implemented as one of the demonstrations of the capabilities of the platform. In this paper the step counting algorithm is described and the performance is evaluated. The application is targeted for running exercise. However, the detection of steps during walking is also discussed.

New Tools for a New Job-Single Port Laparoscopic Surgery Equipment

Single port transumbilical laparoscopic surgery (LESS, SILS, ENOTES) is a technique which has recently emerged with a view to improving the cosmesis following minimal access surgery, aiming to achieve ‘scarless’ surgery. This rapidly progressing technique is facilitated by developments in port and instrument technology, allowing surgeons to perform a wider range of surgical procedures with increasing ease. This paper aims to summarise the equipment available at present for single port surgery.