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Pressure regulator developed for use with cataract-surgery instrument controls intraocular pressure during substantial variations in flow rate of infusion fluid. Device may be applicable to variety of eye-surgery instruments.
The methods proposed for managing fluids and particulate debris during minor surgery on Space Station Freedom (SSF) were investigated and demonstrated. A KC-135 parabolic flight test was performed, in which the flight followed the standard 40 parabola profile with 20 to 25 seconds in near-zero gravity in each parabola. The equipment (suction and laminar flow device) was evaluated. While this equipment performed satisfactorily previously in the dental simulation, the purpose of the current flight was to reconfigure the equipment in support of a minor surgical situation in order to evaluate its efficacy and establish clear requirements for the actual flight hardware. To accomplish the study the Health Maintenance Facility medical restraint system was deployed as for surgical use and mannequin suture arm was restrained to its surface. The surgical area was established as for performing minor surgery with standard tray and suture instruments employed.
The development progress of a precision electro-mechanical instrument which allows the detection and documentation of the forces and moment applied to human tissue during surgery (under actual operation room conditions), is reported. The pen-shaped prototype probe which measures 1/2 inch in diameter and 7 inches in length was fabricated using an aerodynamic balance. The aerodynamic balance, a standard wind tunnel force and moment sensing transducer, measures the forces and the moments transmitted through the surgeon's hand to the human tissue during surgery. The prototype probe which was fabricated as a development tool was tested successfully. The final version of the surgical force detection probe will be designed based on additional laboratory tests in order to establish the full scale loads. It is expected that the final product will require a simplified aerodynamic balance with two or three force components and one moment component with lighter full scale loads. A signal conditioner was fabricated to process and display the outputs from the prototype probe. This unit will be interfaced with a PC-based data system to provide automatic data acquisition, data processing, and graphics display. The expected overall accuracy of the probe is better than one percent full scale.
This paper describes an 8-degrees-of-freedom macro-micro robot. This robot is capable of performing tasks that require accurate force control, such as polishing, finishing, grinding, deburring, and cleaning. The design of the macro-micro mechanism, the control algorithms, and the hardware/software implementation of the algorithms are described in this paper. Initial experimental results are reported. In addition, this paper includes a discussion of medical surgery and the role that force control may play. We introduce a new class of robotic systems collectively called Robotic Enhancement Technology (RET). RET systems introduce the combination of robotic manipulation with human control to perform manipulation tasks beyond the individual capability of either human or machine. The RET class of robotic systems offers new challenges in mechanism design, control-law development, and man/machine interface design. We believe force-controllable mechanisms such as the macro-micro structure we have developed are a necessary part of RET. Work in progress in the area of RET systems and their application to minimally invasive surgery is presented, along with future research directions.
Modification in design of hip implant proposed to increase likelihood of retention of implant in femur after hip-repair surgery. Decreases likelihood of patient distress and expense associated with repetition of surgery after failed implant procedure. Intended to provide more favorable flow of cement used to bind implant in proximal extreme end of femur, reducing structural flaws causing early failure of implant/femur joint.
A preliminary study of corneal abnormalities in intact bovine eyes is presented. Twenty-one eyes were treated with chemicals, cotton swabs, and radial and photo-refractive surgeries. Dynamic and static light scattering was performed as a function of the penetration depth into the corneal tissue. Topographical maps of corneal refractive power from untreated and treated corneas were also obtained using videokeratoscopy and results compared. The ultimate aim is to develop the technique of dynamic light scattering (DLS) for clinical applications in early evaluation of corneal complications after laser-assisted in situ keratomileusis (LASIK) surgeries and other corneal abnormalities.
Pill-shaped biotelemeters originally designed for space flight applications will soon be used for monitoring the health of a fetus during and after in-utero fetal surgery. The authors developed a family of biotelemeters that are not only small enough for rodent studies on board the space shuttle or international space station, but also fit through a 10 mm trocar, a plastic tube that is used in endoscopic fetal surgery to obtain minimally invasive access to the fetus. The first 'pill' measures pressure and temperature, and is currently undergoing long-term leakage and biocompatibility tests. A second pill under development measures pH and temperature. A prototype of the 'pH-pill' has been built and successfully tested and is presently being miniaturized into the same dimensions as the 'pressure pill'. Additional pills measuring heart rate, ECG, other ions such as calcium and potassium, and eventually glucose and blood gases, will follow. All pills are designed for ultra-low power consumption yielding lifetimes of up to 10 months in order to meet the requirements of fetal monitoring, but also to provide the capability of long-term space station experiments. Each pill transmits its pulse-interval-modulated signal on a unique carrier frequency in the frequency range of 174-216MHz. A custom-designed multi-channel receiver demodulates and decodes each pill signal and sends the data to a LabVIEW program that performs real-time data analysis and display. A patent for the pill family and its data analysis system is pending.
In laparoscopic surgery, tiny incisions are made in the patient's body and a laparoscope (an optical tube with a camera at the end) is inserted. The camera's image is projected onto two video screens, whose views guide the surgeon through the procedure. AESOP, a medical robot developed by Computer Motion, Inc. with NASA assistance, eliminates the need for a human assistant to operate the camera. The surgeon uses a foot pedal control to move the device, allowing him to use both hands during the surgery. Miscommunication is avoided; AESOP's movement is smooth and steady, and the memory vision is invaluable. Operations can be completed more quickly, and the patient spends less time under anesthesia. AESOP has been approved by the FDA.
The principal method of dealing with coronary artery blockage is bypass surgery. A non-surgical alternative available to some patients is balloon angioplasty. For several years, medical researchers have been exploring another alternative that would help a wider circle of patients than the balloon treatment and entail less risk than bypass surgery. A research group is on the verge of an exciting development: laser angioplasty with a 'cool' type of laser, called an excimer laser, that does not damage blood vessel walls and offers non-surgical cleansing of clogged arteries with extraordinary precision. The system is the Dymer 200+ Excimer Laser Angioplasty System, developed by Advanced Intraventional Systems. Used in human clinical tests since 1987, the system is the first fully integrated 'cool' laser capable of generating the requisite laser energy and delivering the energy to target arteries. Thirteen research hospitals in the U.S. have purchased Dymer 200+ systems and used them in clinical trials in 121 peripheral and 555 coronary artery cases. The success rate in opening blocked coronary arteries is 85 percent, with fewer complications than in balloon angioplasty. Food and Drug Administration approval for the system is hoped for in the latter part of 1990. * Advanced Intraventional Systems became Spectranetics in 1994 and discontinued the product.
St. Jude Medical's Cardiac Rhythm Management Division's (formerly known as Pacesetter Systems, Inc.) pacer is a rechargeable cardiac pacemaker that eliminates the recurring need for surgery to implant a new battery. The Programalith is an advanced cardiac pacing system which permits a physician to reprogram a patient's implanted pacemaker without surgery. System consists of a pacemaker, together with a physician's console containing the programmer and a data printer. Signals are transmitted by wireless telemetry. Two-way communications, originating from spacecraft electrical power systems technology, allows physician to interrogate the pacemaker as to the status of the heart, then to fine tune the device to best suit the patient's needs.
OBJECTIVE: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass. DESIGN: Prospective clinical study. SETTING: Academic medical center. SUBJECTS: Eighteen elective cardiac surgical patients. INTERVENTION: Cardiac surgery under cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: A near infrared spectroscopic fiber optic probe was placed over the hypothenar eminence. Reference Po2 and pH sensors were inserted in the abductor digiti minimi (V). Data were collected every 30 secs during surgery and for 6 hrs following cardiopulmonary bypass. Calibration equations developed from one third of the data were used with the remaining data to investigate sensitivity of the near infrared spectroscopic measurement to physiologic changes resulting from cardiopulmonary bypass. Near infrared spectroscopic and reference pH and Po2 measurements were compared for each subject using standard error of prediction. Near infrared spectroscopic pH and Po2 at baseline were compared with values during cardiopulmonary bypass just before rewarming commenced (hypotensive, hypothermic), after rewarming (hypotensive, normothermic) just before discontinuation of cardiopulmonary bypass, and at 6 hrs following cardiopulmonary bypass (normotensive, normothermic) using mixed-model analysis of variance. Near infrared spectroscopic pH and Po2 were well correlated with the invasive measurement of pH (R2 =.84) and Po2 (R 2 =.66) with an average standard error of prediction of 0.022 +/- 0.008 pH units and 6 +/- 3 mm Hg, respectively. The average difference between the invasive and near infrared spectroscopic measurement was near zero for both the pH and Po2 measurements. Near infrared spectroscopic Po2 significantly decreased 50% on initiation of cardiopulmonary bypass and remained depressed throughout the bypass and monitored intensive care period. Near infrared spectroscopic pH decreased significantly during cardiopulmonary bypass, decreased significantly during rewarming, and remained depressed 6 hrs after cardiopulmonary bypass. Diabetic patients responded differently than nondiabetic subjects to cardiopulmonary bypass, with lower muscle pH values (p =.02). CONCLUSIONS: Near infrared spectroscopic-measured muscle pH and Po2 are sensitive to changes in tissue perfusion during cardiopulmonary bypass.
Elevated serum levels of insulin-like growth factor binding protein-2 (IGFBP-2) and a precursor form of IGF-II are associated with marked increases in bone formation and skeletal mass in patients with hepatitis C-associated osteosclerosis. In vitro studies indicate that IGF-II in complex with IGFBP-2 has high affinity for bone matrix and is able to stimulate osteoblast proliferation. The purpose of this study was to determine the ability of the IGF-II/IGFBP-2 complex to increase bone mass in vivo. Osteopenia of the femur was induced by unilateral sciatic neurectomy in rats. At the time of surgery, 14-day osmotic minipumps containing vehicle or 2 microg IGF-II+9 microg IGFBP-2/100g body weight/day were implanted subcutaneously in the neck. Bone mineral density (BMD) measurements were taken the day of surgery and 14 days later using a PIXImus small animal densitometer. Neurectomy of the right hindlimb resulted in a 9% decrease in right femur BMD (P<0.05 vs. baseline). This loss in BMD was completely prevented by treatment with IGF-II/IGFBP-2. On the control limb, there was no loss of BMD over the 14 days and IGF-II/IGFBP-2 treatment resulted in a 9% increase in left femur BMD (P<0.05). Bone histomorphometry indicated increases in endocortical and cancellous bone formation rates and in trabecular thickness. These results demonstrate that short-term administration of the IGF-II/IGFBP-2 complex can prevent loss of BMD associated with disuse osteoporosis and stimulate bone formation in adult rats. Furthermore, they provide proof of concept for a novel anabolic approach to increasing bone mass in humans with osteoporosis.
Researchers in space life sciences are rapidly approaching a technology impasse. Many of the critical questions on the impact of spaceflight on living systems simply cannot be answered with the limited available technologies. Research subjects, particularly small animal models like the rat, must be allowed to function relatively untended and unrestrained for long periods to fully reflect the impact of microgravity and spaceflight on their behavior and physiology. These requirements preclude the use of present hard-wired instrumentation techniques and limited data acquisition systems. Implantable sensors and miniaturized biotelemetry are the only means of capturing the fundamental and critical data. This same biosensor and biotelemetry technology has direct application to Earth-based medicine and surgery. Continuous, on-line data acquisition and improved measurement capabilities combined with the ease and flexibility offered by automated, wireless, and portable instruments and data systems, should provide a boon to the health care industry. Playing a key role in this technology revolution is the Sensors 2000! (S2K!) Program at NASA Ames Research Center. S2K!, in collaboration with space life sciences researchers and managers, provides an integrated capability for sensor technology development and applications, including advanced biosensor technology development, spaceflight hardware development, and technology transfer and commercialization. S2K! is presently collaborating on several spaceflight projects with dual-use medical applications. One prime example is a collaboration with the Fetal Treatment Center (FTC) at the University of California at San Francisco. The goal is to develop and apply implantable chemical sensor and biotelemetry technology to continuously monitor fetal patients during extra-uterine surgery, replacement into the womb, through birth and beyond. Once validated for ground use, the method will be transitioned to spaceflight applications to remotely monitor key biochemical parameters in flight animals. Successful application of NASA implantable biosensor and biotelemetry technologies should accelerate the advancement of this and other modern medical procedures while furthering the exploration of life in space.
Two different space life sciences missions (SLS-1 and SLS-2) have demonstrated that the synapses of the hair cells of rat vestibular maculae increase significantly in microgravity. The results also indicate that macular synapses are sensitive to stress. These findings argue that vestibular maculae exhibit neuroplasticity to macroenvironmental and microenvironmental changes. This capability should be clinically relevant to rehabilitative training and/or pharmacological treatments for vestibular disease. The results of this ultrastructural research also demonstrated that type I and type II hair cells are integrated into the same neuronal circuitry. The findings were the basis for development of three-dimensional reconstruction software to learn details of macular wiring. This software, produced for scientific research, has now been adapted to reconstruct the face and skull directly from computerized tomography scans. In collaboration with craniofacial reconstructive surgeons at Stanford University Medical Center, an effort is under way to produce a virtual environment workbench for complex craniofacial surgery. When completed, the workbench will help surgeons train for and simulate surgery. The methods are patient specific. This research illustrates the value of basic research in leading to unanticipated medical applications.
A system with multimodality instrument for tissue identification includes a computer-controlled motor driven heuristic probe with a multisensory tip. For neurosurgical applications, the instrument is mounted on a stereotactic frame for the probe to penetrate the brain in a precisely controlled fashion. The resistance of the brain tissue being penetrated is continually monitored by a miniaturized strain gauge attached to the probe tip. Other modality sensors may be mounted near the probe tip to provide real-time tissue characterizations and the ability to detect the proximity of blood vessels, thus eliminating errors normally associated with registration of pre-operative scans, tissue swelling, elastic tissue deformation, human judgement, etc., and rendering surgical procedures safer, more accurate, and efficient. A neural network program adaptively learns the information on resistance and other characteristic features of normal brain tissue during the surgery and provides near real-time modeling. A fuzzy logic interface to the neural network program incorporates expert medical knowledge in the learning process. Identification of abnormal brain tissue is determined by the detection of change and comparison with previously learned models of abnormal brain tissues. The operation of the instrument is controlled through a user friendly graphical interface. Patient data is presented in a 3D stereographics display. Acoustic feedback of selected information may optionally be provided. Upon detection of the close proximity to blood vessels or abnormal brain tissue, the computer-controlled motor immediately stops probe penetration. The use of this system will make surgical procedures safer, more accurate, and more efficient. Other applications of this system include the detection, prognosis and treatment of breast cancer, prostate cancer, spinal diseases, and use in general exploratory surgery.
A proposed method of surgical repair of fractured bones would incorporate recent and future advances in the art of composite materials. The composite materials used in this method would be biocompatible and at least partly bioabsorbable: that is, during the healing process following surgery, they would be wholly or at least partly absorbed into the bones and other tissues in which they were implanted. Relative to the traditional method, the proposed method would involve less surgery, pose less of a risk of infection, provide for better transfer of loads across fracture sites, and thereby promote better healing while reducing the need for immobilization by casts and other external devices. One requirement that both the traditional and proposed methods must satisfy is to fix the multiple segments of a broken bone in the correct relative positions. Mechanical fixing techniques used in the traditional method include the use of plates spanning the fracture site and secured to the bone by screws, serving of wire along the bone across the fracture site, insertion of metallic intramedullary rods through the hollow portion of the fractured bone, and/or inserting transverse rods through the bone, muscle, and skin to stabilize the fractured members. After the bone heals, a second surgical operation is needed to remove the mechanical fixture(s). In the proposed method, there would be no need for a second surgical operation. The proposed method is based partly on the observation that in the fabrication of a structural member, it is generally more efficient and reliable to use multiple small fasteners to transfer load across a joint than to use a single or smaller number of larger fasteners, provided that the stress fields of neighboring small fasteners do not overlap or interact. Also, multiple smaller fasteners are more reliable than are larger and fewer fasteners. However, there is a trade-off between structural efficiency and the cost of insertion time and materials. The proposed method is further based partly on the conjecture that through-the-thickness reinforcements could be excellent for fixing bone segments for surgical repair. The through-the-thickness reinforcements would superficially resemble nails in both form and function. Denoted small-diameter rods (SDRs) to distinguish them from other narrow rods, these reinforcements would be shot or otherwise inserted through adjacent segments of fractured bone to fix them in their correct relative positions (see figure). Shot insertion would be effected by use an applicator that would amount to a miniaturized and highly refined version of the pneumatic guns often used in carpentry to drive nails and brads. The applicator, envisioned to be about the size of a ball-point-pen, would be driven by pressurized carbon dioxide. To further promote stabilization of the segments, layers of bone glue could be applied to the fracture surfaces prior to insertion of the SDRs. The bone glue could be therapeutically loaded with chemicals to promote growth of bone and fight infection
Introduction: For every one hour spent performing extravehicular activity (EVA) in space, astronauts in the US space program spend approximately six to ten hours training in the EVA spacesuit at NASA-Johnson Space Center's Neutral Buoyancy Lab (NBL). In 1997, NASA introduced the planar hard upper torso (HUT) EVA spacesuit which subsequently replaced the existing pivoted HUT. An extra joint in the pivoted shoulder allows increased mobility but also increased complexity. Over the next decade a number of astronauts developed shoulder problems requiring surgical intervention, many of whom performed EVA training in the NBL. This study investigated whether changing HUT designs led to shoulder injuries requiring surgical repair. Methods: US astronaut EVA training data and spacesuit design employed were analyzed from the NBL data. Shoulder surgery data was acquired from the medical record database, and causal mechanisms were obtained from personal interviews Analysis of the individual HUT designs was performed as it related to normal shoulder biomechanics. Results: To date, 23 US astronauts have required 25 shoulder surgeries. Approximately 48% (11/23) directly attributed their injury to training in the planar HUT, whereas none attributed their injury to training in the pivoted HUT. The planar HUT design limits shoulder abduction to 90 degrees compared to approximately 120 degrees in the pivoted HUT. The planar HUT also forces the shoulder into a forward flexed position requiring active retraction and extension to increase abduction beyond 90 degrees. Discussion: Multiple factors are associated with mechanisms leading to shoulder injury requiring surgical repair. Limitations to normal shoulder mechanics, suit fit, donning/doffing, body position, pre-existing injury, tool weight and configuration, age, in-suit activity, and HUT design have all been identified as potential sources of injury. Conclusion: Crewmembers with pre-existing or current shoulder injuries or certain anthropometric body types should conduct NBL EVA training in the pivoted HUT.
Topics covered include: Cryogenic Temperature-Gradient Foam/Substrate Tensile Tester; Flight Test of an Intelligent Flight-Control System; Slat Heater Boxes for Thermal Vacuum Testing; System for Testing Thermal Insulation of Pipes; Electrical-Impedance-Based Ice-Thickness Gauges; Simulation System for Training in Laparoscopic Surgery; Flasher Powered by Photovoltaic Cells and Ultracapacitors; Improved Autoassociative Neural Networks; Toroidal-Core Microinductors Biased by Permanent Magnets; Using Correlated Photons to Suppress Background Noise; Atmospheric-Fade-Tolerant Tracking and Pointing in Wireless Optical Communication; Curved Focal-Plane Arrays Using Back-Illuminated High-Purity Photodetectors; Software for Displaying Data from Planetary Rovers; Software for Refining or Coarsening Computational Grids; Software for Diagnosis of Multiple Coordinated Spacecraft; Software Helps Retrieve Information Relevant to the User; Software for Simulating a Complex Robot; Software for Planning Scientific Activities on Mars; Software for Training in Pre-College Mathematics; Switching and Rectification in Carbon-Nanotube Junctions; Scandia-and-Yttria-Stabilized Zirconia for Thermal Barriers; Environmentally Safer, Less Toxic Fire-Extinguishing Agents; Multiaxial Temperature- and Time-Dependent Failure Model; Cloverleaf Vibratory Microgyroscope with Integrated Post; Single-Vector Calibration of Wind-Tunnel Force Balances; Microgyroscope with Vibrating Post as Rotation Transducer; Continuous Tuning and Calibration of Vibratory Gyroscopes; Compact, Pneumatically Actuated Filter Shuttle; Improved Bearingless Switched-Reluctance Motor; Fluorescent Quantum Dots for Biological Labeling; Growing Three-Dimensional Corneal Tissue in a Bioreactor; Scanning Tunneling Optical Resonance Microscopy; The Micro-Arcsecond Metrology Testbed; Detecting Moving Targets by Use of Soliton Resonances; and Finite-Element Methods for Real-Time Simulation of Surgery.