ROBOTIC SURGERY

Robotic surgery is the use of robots in performing surgery.


(ROBOTIC SURGERY)

Three major advances aided by surgical robots are :

i.)Remote Surgery


(REMOTE ROBOT SURGERY)

ii.)Minimally invasive Surgery


(Minimal Invasive Robot Surgery)

iii.)Unmanned Surgery.


(UNMANNED ROBOT SURGERY)

ADVANTAGES OF ROBOTIC SURGERY :

Major potential advantages of robotic surgery are

i.)Precision and Miniaturization.
ii.)Articulation beyond normal manipulation and
iii.)Three-dimensional magnification.

Some surgical robots are autonomous, not under control of a surgeon.


(VARIOUS CONCEPTS IN AUTOMATIC CONTROL ROBOTS)

HISTORY OF ROBOTIC SURGERY

In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance.


(PUMA 560 ROBOT)

In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery.


(PROBOT ROBOT)

The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement.


(ROBODOC ROBOT HIP SURGERY)

Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system.


(DA VINCI SURGICAL SYSTEM ROBOT)

Intuitive Surgical purchased Computer Motion in 1994 and discontinued development of the ZEUS System.



DA VINCI SURGICAL SYSTEM



The da Vinci Surgical System is comprised of three components: a surgeon’s console, a patient-side robotic cart with four arms manipulated by the surgeon, and a high-definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The surgeon’s hand movements are scaled and filtered to eliminate hand tremor then translated into micro-movements of the proprietary instruments.


(DA VINCI ROBOT SYSTEM, A- SURGEON CONSOLE, B- 3D VISION SYSTEM, C- PATIENT SIDE ROBOT CART WITH 4 ARMS)


(DA VINCI ROBOT ARMS)


(VIEW OF DA VINCI ROBOT SYSTEM SURGERY)

The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair and used in more than 800 hospitals in the Americas and Europe. The da Vinci System was used in 48,000 procedures in 2006 and sells for about $1.2 million.

In May 1998, Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany.

In 2001, Marescaux used the Zeus robot to perform a cholecystectomy on a patient in Strasbourg, France while in New York.

The first unmanned robotic surgery took place in May 2006 in Italy.

Applications



Cardiac surgery

Endoscopic coronary bypass surgery and mitral valve replacement have been performed. Totally closed chest, endoscopic mitral valve surgeries are being performed now with the robot.



Gastrointestinal surgery

Multiple types of procedures have been performed with either the Zeus or da Vinci robot systems, including bariatric surgery.


(GASTROINTESTINAL BARIATIC ROBOT SURGERY)



(SURGICAL ROBOT PARTS)


Gynecology

Reproductive surgery and ablative surgery including hysterectomy have been performed.





Neurosurgery

Several systems for stereotactic intervention are currently on the market.






Orthopedics

The ROBODOC system was released in 1992 by the Integrated Surgical Systems, Inc.



Pediatrics

Surgical robotics has been used in many types of pediatric surgical procedures including:
i.)Tracheoesophageal fistula repair,
ii.)Cholecystectomy,
iii.)Nissen fundoplication,
iv.)Morgagni hernia repair,
v.)Kasai portoenterostomy,
vi.)Congenital diaphragmatic hernia repair, and others.


(SURGICAL ROBOT ARMS)

On January 17, 2002, surgeons at Children's Hospital of Michigan in Detroit performed the nation's first advanced computer-assisted robot-enhanced surgical procedure at a children's hospital.


For more Robotic Surgery Articles, Visit
1.) Robotic Surgery Institute
2.)Cardiac Surgery Associates

ARTIFICIAL HEART & HEART ASSIST DEVICES

An artificial heart is a prosthetic device that is implanted into the body to replace the biological heart. It is distinct from a cardiopulmonary bypass machine (CPB) / Heart-Lung machine, which is an external device used to provide the functions of both the heart and the lungs.





The CPB oxygenates the blood, so does not need to be connected to both blood circuits. Also, a CPB is only suitable for a few hours use, while artificial hearts have so far been used for periods of long over a year.


(ARTIFICIAL HEART)

Origins

A synthetic replacement for the heart remains one of the long-sought holy grails of modern medicine.


(HEART TRANSPLANT)


(HEART TRANSPLANT)

The obvious benefit of a functional artificial heart would be to lower the need for heart transplants, because the demand for donor hearts (as it is for all organs) always greatly exceeds supply.


(ARTIFICIAL HEAT PARTS)

Although the heart is conceptually simple (basically a muscle that functions as a pump), it embodies subtleties that defy straightforward emulation with synthetic materials and power supplies. Consequences of these issues include severe foreign-body rejection and external batteries that limit patient mobility. These complications limited the lifespan of early human recipients to hours or days.

EARLY DESIGNS

A heart-lung machine was used in 1953 during the first successful open heart surgery.


(FIRST HEART-LUNG MACHINE)

Dr. John Heysham Gibbon performed the operation and developed the heart-lung substitute himself. Whether this device could be considered as an artificial heart is a subject of debate.


(Dr.John Gibbon, Mrs.Mary Gibbon & Heart-Lung Machine)

The first patented artificial heart was invented by Paul Winchell in 1963.



Winchell subsequently assigned the patent to the University of Utah, where Robert Jarvik ultimately used it as the model for his Jarvik-7.


Jarvik-7 Artificial Heart, front view (left), back view (right)



Jarvik's designs improved the device, but his patients succumbed after brief trials. His first Jarvik-7 patient, 61-year-old retired dentist Barney Clark, survived for 112 days after it was implanted at the University of Utah on December 2, 1982.


(Dr. Robert Jarvik, inventor of the artificial heart, Jarvik-7, holds up a model like the one implanted in Barney Clark on Dec. 3, 1982. )

One of the innovations of the Jarvik-7 was the inner coating of rough material, developed by David Gernes. This coating helped the blood to clot and coat the inside of the device, enabling a more natural blood flow.

After about 90 people received the Jarvik device, the implantation of artificial hearts was banned for permanent use in patients with heart failure, because most of the recipients could not live more than half a year. However, it is used temporarily for some heart transplantation candidates who cannot find a natural heart immediately but urgently need an efficiently working heart.

Hiroaki Harasaki of the Cleveland Clinic developed two important improvements for the artificial heart and projected future artificial organs.


(Faculty researchers (from left) Jaikrishnan Kadambi and Hiroaki Harasaki and graduate student Stefan Baumann examine some of the features of their pulsatile heart loop that mechanically simulates how the blood flows through the heart.)

The two patented inventions solved major obstacles for any fully implanted artificial organs and materials. The first was a non-clotting surface material which significantly reduces the risk of rejection of the organ by the patient's immune system. The second development, which required the collaboration of many disciplines, was an implantable power source which does not create tissue-damaging heat.

DIFFERENCE BETWEEN JARVIK & ABIOCOR ARTIFICIAL HEARTS


(CLICK PICTURE TO ENLARGE)

Recent developments



On July 2, 2001, Robert Tools received the AbioCor Implantable Replacement Heart produced by the AbioMed company of Danvers, Massachusetts. It was the first completely self-contained artificial heart transplant. The surgery was done by University of Louisville doctors at Jewish Hospital in Louisville, Kentucky.



Tom Christerson survived for 17 months after another AbioCor transplant. On September 6, 2006 the AbioCor device became the first fully implantable artificial heart to be approved under 'Humanitarian Use Device' rules.



The 'CardioWest' temporary Total Artificial Heart (TAH‑t) was developed from the Jarvik-7 by University of Arizona researchers and approved for use in 2004. It is the first implantable artificial heart to be approved by the U.S. Food and Drug Administration, and has also been approved by the CE.


(CARDIOWEST TAH-t ARTIFICIAL HEART)



The TAH-t is used only in patients with end stage biventricular failure as a way to improve life expectancy while they are waiting for a heart transplant. In a pivotal clinical study, these patients were successfully transplanted 79% of the time; One-year and five-year survival rates after heart transplant among these patients were 86 and 64 percent. The longest TAH‑t implantation so far went 602 days (20.4 months). There are several medical centers where this device can be implanted:

United States:

- University Medical Center (Tucson, AZ)

- Cleveland Clinic (Cleveland, OH)

- Virginia Commonwealth University Health System (Richmond, VA)

- Aurora St. Luke's (Milwaukee, WI)

- University of Michigan Health System (Ann Arbor, MI)

- Penn State Hershey Medical Center (Hershey, PA)

- Ohio State University Medical Center (Columbus, OH)

- Hospital of the University of Pennsylvania (Philadelphia, PA)

- Barnes Jewish Hospital (St. Louis, MO)

Canada:

- Montreal Heart Institute (Quebec, Canada)

Europe:

- Groupe Hospitalier La Pitié-Salpêtrière (Paris, France)

- Hôpital Guillaume et René Laennec (Nantes, France)

- Deutsches Herzzentrum Berlin / German Heart Institute Berlin (Berlin, Germany)

- Herz-und Diabeteszentrum Nordrhein Westfalen / Heart and Diabetes Center (Bad Oeynhausen, Germany)

- Herzzentrum Leipzig GmbH Universitaetsklinik (Leipzig, Germany)

- Universitäts Klinikum Freiburg (Freiburg, Germany)

- Universitätsklinikum Münster (Munster, Germany)

- Herzzentrum Köln (Cologne, Germany)

- University Hospital Munich (Munich, Germany)

- Friedrich-Alexander University Hospital (Nuremburg, Germany)

With increased understanding of the heart and continuing improvements in prosthetics engineering, computer science, electronics, battery technology, and fuel cells, a practical artificial heart may be a reality in the 21st century.

Heart assist devices


(THORATEC HEARTMATE VENTRICULAR ASSIST DEVICE)

Patients who have some remaining heart function but who can no longer live normally may be candidates for ventricular assist devices which do not replace the heart, but boost its output.



The first heart assist device was FDA approved in 1994, and two more received approval in 1998. While the original assist devices emulated the pulsating heart newer versions, such as the Heartmate II, developed by the Texas Heart Institute of Houston, Texas, provide continuous flow.



These pumps (which may be cetrifugal or axial flow) are smaller and potentially more durable and long-lasting than the current generation of total heart replacement pumps. Several continuous flow ventricular assist devices have been approved for use in the European Union and as at August 2007 were undergoing clinical trials for FDA approval.

VENTRICULAR ASSIST DEVICE:


(Line drawing of how VentrAssist device is implanted )

1.)Natural Heart is not removed.
2.)A short inflow cannula is attached to left ventricle which delivers blood from heart to the device.
3.)The outflow cannula from the pump delivers blood from the device to the ascending aorta, the major artery supporting the body.
4.)Device is then implanted in the "pump-pocket" which is located on the left side of the body, behind the muscles of the abdominal wall and below the rib cage. The drive line from the pump exits from the right side of the abdomen below the ribs.
5.)This connects the pump to the controller and batteries worn on an external belt or backpack.

VentrAssist is the world's leading artificial heart assist device. It is designed as a permanent alternate to heart transplant as well as a bridge to transplant (BTT) or a bridge to recovery (BTR). It is a blood pump that is connected to the left ventricle of a diseased heart to help the ailing heart's pumping action. The device has only one moving part - a hydrodynamically suspended impeller. It is designed to have no wearing parts or cause blood damage. It weighs 298g and is less than 6cm in diameter, making it suitable for both children and adults. The implanted parts of the device are constructed using materials that are fully biocompatible including titanium alloys. It has a diamond-like coating on blood contacting surfaces. The device is powered by an external battery pack with each rechargeable battery set lasting about 8 hours, but also being mains operable. The global market for devices such as VentrAssist will grow to between $7.5 billion and $12 billion annually in the next few years.

MORE PICTURES:

ARTIFICIAL HEART:




ARTIFICIAL HEART PICTURE


ABICOR ARTIFICIAL HEART


ABICOR HEART PUMP

ABICOR HEART


JARVIK-7 ARTIFICIAL HEART


JARVIK 2000 HEART PUMP

HEART ASSIST DEVICES:


VENTRICULAR ASSIST DEVICE PICTURE


ELECTRIC LEFT VENTRICULAR ASSIST DEVICES


PNEUMATIC LEFT VENTRICULAR ASSIST DEVICES




Further Readings For :
1.) HOW ARTIFICIAL HEART WORKS
2.) HEART ASSIST DEVICES
3.) ARTIFICIAL HEARTS

GLUCOBAND & GLUCOWATCH

GLUCOBAND




The Glucoband is a compact electronic scanning device that utilizes a bio-electromagnetic resonance phenomenon to non-invasively measure blood glucose levels in the human body, and to continuously monitor the blood glucose level. The device is based on the technology called Bio-Electric Impedance Spectroscopy (BEIS).

A wrist-watch-like Glucoband, with fully integrated LCD screen, electronic circuits, integrated electrodes, battery and adjustable wrist-band, is placed on the person's wrist. The initial measurement process takes only a few minutes, however, in the monitoring mode, measurements can be continuous and only the frequency of measurements must be determined. The Glucoband targets diabetics who are measuring their own blood glucose, and medical personnel who are using blood glucose measuring and monitoring devices in clinics, hospitals and other point-of-care facilities. The measurements meet FDA requirements for accuracy and correlation.

The design of the Glucoband is such that it may be used as a regular wrist-watch or be used as a blood glucose measurement device, at the discretion of the wearer.In the Continuous Monitoring mode, Glucoband can be set to alert upon surpassing a lowest and/or highest preset value.

Glucoband worn on the wrist like regular wristwatch would allow people with diabetes to continuously and non-invasively monitor their blood glucose levels without the pain and inconvenience of multiple fingerstick blood tests or implanting a sensor. Prototypes of the device have shown the capability of providing readings once in 6 minutes.

Continuous glucose monitoring has become an important component of diabetes management for both children and adults.Blood glucose levels are a measure of an individual's health status. Because people with diabetes cannot properly metabolize glucose, they typically monitor their glucose levels by frequently pricking their fingertips to draw the drop of blood necessary for conventional glucose monitoring. The estimated worldwide market for glucose testing is $5.5 billion with an annual growth rate of 15 to 18 percent.


GLUCOWATCH

The Cygnus GLUCOWATCH wrist monitor uses a low electric current to pull glucose through the skin. The system, which employs a disposable sensor pad to collect and measure the glucose sample, provides automatic glucose readings up to three times an hour for as long as twelve hours at a time.


(CYGNUS GLUCOWATCH)

Cygnus GLUCOWATCH G2 BIOGRAPHER, a special version of the GLUCOWATCH is designed for younger diabetic patients aged 7 to 17. It gained FDA approval in May 2005.




Reference : CALISTOMEDICAL

GLUCOPHONE

GLUCOMETER + CELL PHONE = GLUCOPHONE

Glucophone is a new technology that integrates a blood glucose meter with a standard cellphone. It not only allows you to send results over the air, but specially equipped mobiles will actually be fitted with a GlucoPack that enables you to test Glucose level yourself as you would do with any other traditional glucometer.


(LG GLUCOPHONE)

Glucophone is essentially a cellphone and glucometer. It will measure blood sugar levels, record and send results to yourself and others.

GLUCOPHONE

A company called Healthpia America has developed an integrated cell phone-glucometer system that "uses custom software along with an LG UX5000, VX5200, or LX350 and a Glucopack." According to the company's website, they believe that their system is "the world's first, all-in-one, glucometer cell phone and service for managing diabetes remotely. Whether you're a guardian, physician, or healthcare institution, you can provide 24/7 support and emergency intervention to Diabetes Phone subscribers -- anytime, anywhere. It's a full disease management system."



WORKING OF GLUCOPHONES

HealthPia has developed a glucose meter (GlucoPack™) that can be fitted onto regular cell phones.



The customer uses the GlucoPack™ in the same manner as any standard glucose meter.



Software has been developed that can be downloaded into your cell phone that can interface with the GlucoPack™ to test and read your glucose level.

(When you go visit or talk to your doctor or a hospital, with the subscriber's permission all the test results are accessible online.)



The test reslults are stored in the cell phone and also sent to an online medical management database. The results can also be automatically sent to other sources such as your physician, guardian, family members in real-time at the subscriber's direction.

(When you go visit or talk to your doctor or a hospital, with the subscriber's permission all the test results are accessible online.)



The disease management center analyzes the test results and provides professional medical management for the subscriber.


Reference : HealthPia

Blood glucose monitoring

Blood glucose monitoring is a way of testing how much glucose is in the blood (glycemia).



i.)This is important in the care of diabetes mellitus. Most people with Type 2 diabetes need to test at least once per day (usually before breakfast) to assess the effectiveness of their diet and exercise for controlling their blood glucose levels. Many people with Type 2 are using an oral medication to combat their insulin resistance, and must test their blood glucose before and after breakfast to assess the effectiveness of their dosage.



ii.)All people who need to inject insulin, both for Type 1 diabetes and Type 2, need also to test their blood sugar more often (3 to 10 times per day) to assess the effectiveness of their prior insulin dose and to calculate their next insulin dose.

DIABETES MELLITUS TYPE 1



Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of diabetes mellitus. Type 1 diabetes is an autoimmune disease that results in the permanent destruction of insulin producing beta cells of the pancreas.



Type 1 is lethal unless treatment with exogenous insulin via injections replaces the missing hormone.





DIABETES MELLITUS TYPE 2





Diabetes mellitus type 2 (formerly called diabetes mellitus type II, non insulin-dependent diabetes (NIDDM), obesity related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia.



It is often managed by engaging in exercise and modifying one's diet.



It is rapidly increasing in the developed world, and there is some evidence that this pattern will be followed in much of the rest of the world in coming years.

Improved technology for measuring blood glucose is rapidly changing the standards of care for all diabetic people. There are several methods of blood glucose testing currently available.

CHEMICAL TEST STRIPS

Chemical test strips are a low cost method for monitoring blood glucose. A fairly large drop of blood, usually taken from the fingertip, is placed on a chemically prepared strip, called a blood glucose testing strip.The strip chemistry will cause it to change color according to the amount of glucose is in the blood.



One can tell if their level of blood glucose is low, high, or normal by comparing the color on the end of the strip to a color chart that is printed on the side of the test strip container.







These are recommended only for people who are occasionally monitoring their blood glucose level (prediabetic or type 2) and are not using insulin.

The Betachek Diabetes Test Strips


BLOOD GLUCOSE METERS



A blood glucose meter is an electronic device for measuring the blood glucose level. A relatively small drop of blood is placed on a disposable test strip which interfaces with a digital meter. Within several seconds, the level of blood glucose will be shown on the digital display.







While more expensive, blood glucose meters seem a breakthrough in diabetes self care. As the drops of blood needed for the meter become smaller, the pain associated with testing is reduced and the compliance of diabetic people to their testing regimens is improved. Although the cost of using blood glucose meters seems high, it is believed to be a cost benefit relative to the avoided medical costs of the complications of diabetes.

A recent and welcome advance is the use of small blood drops for blood glucose testing from other places than the finger tips.



This alternate site testing uses the same test strips and meter, is practically pain free, and gives the real estate on the finger tips a needed break if they become sore.


(ALTERNATE SITE GLUCOSE TEST- BLOOD TAKEN FROM FOREARM INSTEAD OF FINGER)


CONTINUOUS BLOOD GLUCOSE MONITORING (AMBULATORY)

A continuous blood glucose monitor determines blood glucose levels on a continuous basis (every few minutes). A typical system consists of:

i.)a disposable glucose sensor placed just under the skin, which is worn for a few days until replacement,


(A-INSULIN PUMP, B-CANNULA, C-TINY GLUCOSE SENSOR, D-REAL TIME TRANSMITTER)

ii.)a link from the sensor to a non-implanted transmitter which communicates to a radio receiver,



iii.)an electronic receiver worn like a pager (or insulin pump) that displays blood glucose levels on a practically continuous manner, as well as monitors rising and falling trends in glycemic excursions.





Continuous blood glucose monitors measure the glucose level of interstitial fluid. Disadvantages compared to traditional blood glucose monitoring are:

i.)continuous systems must be calibrated with a traditional blood glucose measurement (using current technology) and therefore do not yet fully replace "fingerstick" measurements.
ii.)glucose levels in interstitial fluid lag temporally behind behind blood glucose values.

Patients therefore require traditional fingerstick measurements for calibration (typically twice per day) and are often advised to use fingerstick measurements to confirm hypo- or hyperglycemia before taking corrective action.

The lag time discussed above has been reported to be about 5 minutes.Anecdotally, some users of the various systems report lag times of up to 10-15 minutes. This lag time is insignificant when blood sugar levels are relatively consistent. However, blood sugar levels, when changing rapidly, may read in the normal range on a CGM system while in reality the patient is already experiencing symptoms of an out-of-range blood glucose value and may require treatment. Patients using CGM are therefore advised to consider both the absolute value of the blood glucose level given by the system as well as any trend in the blood glucose levels. For example, a patient using CGM with a blood glucose of 100 mg/dl on their CGM system might take no action if their blood glucose has been consistent for several readings, while a patient with the same blood glucose level but whose blood glucose has been dropping steeply in a short period of time might be advised to perform a fingerstick test to check for hypoglycemia.

Continuous monitoring allows examination of how the blood glucose level reacts to insulin, exercise, food, and other factors. The additional data can be useful for setting correct insulin dosing ratios for food intake and correction of hyperglycemia. Monitoring during periods when blood glucose levels are not typically checked (e.g. overnight) can help to identify problems in insulin dosing (such as basal levels for insulin pump users or long-acting insulin levels for patients taking injections). Monitors may also be equipped with alarms to alert patients of hyperglycemia or hypoglycemia so that a patient can take corrective action(s) (after fingerstick testing, if necessary) even in cases where they do not feel symptoms of either condition. While the technology has its limitations, studies have demonstrated that patients with continuous sensors experience less hyperglycemia and also reduce their glycated hemoglobin levels.

Currently, continuous blood glucose monitoring is not automatically covered by health insurance in the United States in the same way that most other diabetic supplies are covered (e.g. standard glucose testing supplies, insulin, and even insulin pumps). However, an increasing number of insurance companies do cover continuous glucose monitoring supplies (both the receiver and disposable sensors) on a case-by-case basis if the patient and doctor show a specific need. The lack of insurance coverage is exacerbated by the fact that disposable sensors must be frequently replaced (sensors by Dexcom and Minimed have been FDA approved for 7- and 3-day use, respectively, though some patients wear sensors for longer than the recommended period) and the receiving meters likewise have finite lifetimes (less than 2 years and as little as 6 months). This is one factor in the slow uptake in the use of sensors that have been marketed in the United States.

Some current and future continuous glucose monitoring products include:
i.)The Freestyle Navigator
ii.)Minimed Paradigm insulin pump plus a continuous sensor
iii.)The Guardian by Minimed
iv.)Dexcom STS
v.)GlucoDay S

See this summary by a diabetes support group for a review of CBGM products, performance, and features.

This technology is an important component in the effort to develop a closed-loop system connecting real-time automatic control of an insulin pump based on immediate blood glucose data from the sensor. One important goal is to develop an algorithm for automatic control, by which the system would function as an artificial pancreas. Although sensor reliability is more than adequate to improve outcomes for patients when used in an "open-loop" setting where the patient makes judgments about delivery of insulin, it is clearly not ready to be used as part of a closed loop system. FDA had approved the technology for use only in combination with fingerstick testing, and patients are expected to make judgments about treatment only after taking a fingerstick test. Therefore it is overly optimistic to think that these devices will be part of a closed loop system in the near future.

GLUCOSE SENSING BIOIMPLANTS

Longer term solutions to continuous monitoring, not yet available but under development, use a long-lasting bio-implant. These systems promise to ease the burden of blood glucose monitoring for their users, but at the trade off of a minor surgical implantation of the sensor that lasts from one year to more than five years depending on the product selected.

Products under development include:
i.)The SMSI Glucose Sensor
ii.)The Animas Glucose Sensor
iii.)Implanted Glucose Bio-sensor
iv.)The Dexcom LTS (long term system)


NON INVASIVE BLOOD GLUCOSE MONITORING TECHNOLOGY

Some new technologies to monitor blood glucose levels will not require access to blood to read the glucose level. Non-invasive technologies include near IR detection, ultrasound and dielectric spectroscopy. These will free the person with diabetes from finger sticks to supply the drop of blood for blood glucose analysis.



Most of the non-invasive methods under development are continuous glucose monitoring methods and offer the advantage of providing additional information to the subject between the conventional finger stick, blood glucose measurements and over time periods where no finger stick measurements are available (i.e. while the subject is sleeping).



Products under development include:
i.)Fovioptics retinal glucose analyzer
ii.)Inlight Solutions, NIR glucose sensor
iii.)NIR Diagnostics, NIR glucose sensor
iv.)Sinsys Medical GTS
v.)Solianis Monitoring AG

VARIOUS MODELS OF MODERN GLUCOMETER








(COMBINED DIGITAL BP MONITOR & GLUCOMETER")



(ALTERNATE SITE TESTING GLUCOMETER)

SYMPTOMS,TESTS & ADVICE FOR DIABETIC PATIENTS

1.)


2.)HYPERGLYCEMIA(HIGH BLOOD GLUCOSE) & HYPOGLYCEMIA (LOW BLOOD GLUCOSE) SYMPTOMS


(HYPERGLYCEMIA)




This method of treating low blood sugars is called the 15:15 rule. Eat 15 grams of carbohydrate and wait 15 minutes

3.)Fasting plasma glucose test -- this is the simplest and fastest way to measure blood glucose and diagnose diabetes. Fasting means that you have had nothing to eat or drink (except water) for 8 to 12 hours before the test. You are diagnosed with diabetes if your blood glucose level is 126 mg/dl or greater on two separate tests.



4.)Oral glucose tolerance test -- your blood glucose is tested two hours after drinking 75 grams of glucose. You are diagnosed with diabetes if your blood glucose level is 200 mg/dl or greater.





5.)A person with type 2 diabetes can use exercise to help control their blood sugar levels and provide energy their muscles need to function throughout the day. By maintaining a healthy diet and sufficient exercise, a person with type 2 diabetes may be able to keep their blood sugar in the normal non-diabetic range without medication.


(BEFORE & AFTER EXERCISES)

6.)RISKS OF DIABETES

AMBULATORY BLOOD PRESSURE MONITOR

Ambulatory blood pressure monitoring (ABPM) measures blood pressure at regular intervals throughout the day and night. It is believed to be able to reduce the white coat hypertension effect.

BLOOD PRESSURE & HYPERTENSION



Blood pressure is the force that pushes blood through the blood vessels in your body. In people who have high blood pressure, blood is pushed through the blood vessels with greater force than normal. Another word for high blood pressure is "hypertension."





CAUSES OF HIGH BLOOD PRESSURE

1.)A diet high in fat and cholesterol
2.)Not exercising regularly or not exercising hard enough
3.)Being overweight
4.)A family history of high blood pressure
5.)Tobacco use
6.)Stress
7.)Some birth control medicines
8.)Kidney and hormone problems


SYSTOLE & DIASTOLE



Blood pressure is recorded as two numbers separated by a slash, like 120/80. The first number is the systolic (say: "sis-tol-ik") pressure; it is the force when the heart pumps. The second number is the diastolic (say: "die-uh-stol-ik") pressure; it is the force when the heart relaxes between beats.




SYSTOLIC & DIASTOLIC READINGS

Knowing both of your blood pressure readings can help your doctor tell if you have high blood pressure. Your doctor will want you to keep your usual blood pressure lower than 140/90. If you have diabetes, your doctor will want you to keep your blood pressure lower than 130/85.









EFFECTS OF HIGH BP ON BODY PARTS

High blood pressure can damage many parts of the body. If patient has high blood pressure, he/she has a higher risk for stroke, heart disease, heart attacks and kidney failure. Control of the blood pressure can reduce these risks.













ASSESSMENT & DIAGNOSIS OF HYPERTENSIVE PATIENTS


(CLICK IMAGE TO ENLARGE)


AMBULATORY BP MONITOR



It is a small machine, about the size of a portable radio. The Patient will wear it on a belt. The blood pressure cuff on the monitor can be worn under his/her clothes without anyone seeing it. The picture to thebelow shows a person wearing an ambulatory blood pressure monitor.



This machine lets doctor find out what patient's blood pressure was every 15 to 30 minutes of a normal day.The information collected by this machine can help patient and doctor see if the blood pressure treatment is working.

The doctor may want patient to use an ambulatory blood pressure monitor for one or more of the following reasons:

1.)If patient has "borderline" high blood pressure
2.)If patient and doctor can't keep your blood pressure under control
3.)If patient has blood pressure problems caused by other medicines
4.)If patient is pregnant and has high blood pressure
5.)If patient has fainting spells

The monitor may help doctor find out if patient is a person who only has high blood pressure when you are at the doctor's office. This is called "white-coat hypertension." If patient has this kind of hypertension, he/she may not need to take medicine.

WORK OF AMBULATORY BP MONITOR ON PATIENT

The small blood pressure cuff that is connected to the monitor will automatically check patient's blood pressure about every 30 minutes, even while he/she is sleeping. The patient also will be asked to keep a diary of his/her day's activities, so doctor will know when he/she was active and when she/she was resting. Some people feel a little sore from the frequent pressure checks. Some people get a rash, but it usually goes away without treatment.



After 24 hours of monitoring, patient will take the machine and diary to the doctor's office. The blood pressure information is transferred from the monitor to a computer or an analyzer. The computer helps the doctor make sense of the information. Your doctor will review the information with you and decide if your treatment program is working or if you need to make changes to it.






ADVICE FOR HIGH BP PATIENTS