Adobe Systems Department of Biophysics, Medical Faculty, Masaryk University in Brno 1 Lectures on Medical Biophysics Devices for substitution and assist of body organs Adobe Systems Support and replacement of heart 2 The artficial heart Two pumps with an external pneumatic drive Mr Halik sits in front of a graphic explaining how the two heart pumps keep him alive Man, who lived half a year with pair of rotation pumps Heartmate 2 without heart and pulse. https://38.media.tumblr.com/tumblr_lmtajvFQq81qf00w4.jpg Adobe Systems 3 ̶During major heart or lungs surgery is often necessary to substitute function of these organs by an extracorporeal device. The lungs are substituted by oxygenator, which delivers oxygen to the body and removes carbon dioxide from it. ̶Two types of oxygenators: with direct contact of the gas with blood or based on diffusion of gases through a membrane between blood and gas. ̶In the bubble oxygenators, the oxygen bubbles ascend in a cylindrical vessel filled by blood. Blood uptakes oxygen and carbon dioxide is removed. Arising foam must be settled, then the blood passes through a filter and the „bubble trap“. ̶Membrane oxygenators are equipped by semipermeable membranes. Problem: certain denaturation of blood proteins and damage to the blood cells on the membranes limit their use to several hours. The membranes are layered or form capillaries. These oxygenators represent good approximation of lungs but it is necessary to disturb the blood layer on membranes by turbulences. ̶ Cardiopulmonary bypass 4 Cardiopulmonary bypass 6 Main parts of cardiopulmonary bypass: peristaltic pump, oxygenator, heat exchanger for heating or cooling blood and hence the patient’s body. Membrane oxygenator The common problem of all cardiopulmonary bypasses is the need of certain increase of circulating blood volume – it can be done by dilution. 5 Pacemaker rtg PROGR kardio programmer Pacemakers are used in patients with severe arrhythmias and some other heart diseases. This active implantable device consists of electrodes and a central unit driven by durable batteries. They can be programmed from outside the body according the patient’s conditions. They replace the natural pacemaker – the sinoatrial node. 6 Defibrillators preview?d=ci&l=03070901f1 preview?d=ci&l=03060900f2 z_viden_4 Defibrillators are used in emergency medicine to renew spontaneous heart activity (in case of chamber fibrillation). Implantable defibrillator/cardioverter Jan Bělohlávek se svým týmem implantoval 25. června v Pardubické krajské nemocnici kardioverter-defibrilátor se dvěma elektrodami (na snímku) pacientovi po infarktu. 7 „Iron lungs“ (in the past) www.blinn.edu/natscience/phillips/ironlung.html IronLung1 bl_8 Poliomyelitis (polio) treatment in 50´. Later was the problem solved by the Salk vaccine. Adobe Systems 8 Mechanical ventilation of lungs ̶Ventilation is performed with air pressure or volume limit fig10-1small FullVent-small http://www.mtsinai.org/pulmonary/books/physiology/chap10a.htm Homework: Look for ECMO!!! 9 Artificial kidney - haemodialysis dialyser Superfluous volume of blood can be removed by underpressure in the dialysis solution Arterial end (arm) Diluent added to blood Dialyser - artificial kidney Waste outlet Venous end (arm) “bubble trap” Dialysis solution According to: www.renalpatients.co.uk/ haemodialysis.htm. www.rheomed.de/Bilder/ produkte/dialyser.jpg Adobe Systems 10 Peritoneal dialysis www.devicelink.com/ expo/awards02/98winQ.html. www.healthyeatingliving.com/ Kidney_failure.htm. ww5rl64 mde2_r Peritoneal dialysis can be done by the patient at home. A catheter is permanently inserted into the peritoneal cavity and serves for application as well as removal of dialysis solution. The procedure can be automated and performed during sleep. 11 Haemofiltration According to: info-dialyse.de/.../ haemo_haemofiltration.php. Hemofiltration is an alternative of dialysis. It is very useful in some poisonings. Hemofiltrate with toxic substances is replaced by substitution solution added to blood in necessary amount. High-flow-rate membrane pump Balancing of fluids Substitution solution haemo-filtrate 12 Artificial pancreas – insulin pump http://www.diabetesaustralia.com.au/conquest/0204-insulin-pump-therapy.htm www.pnl.gov/ energyscience/06-01/ws.htm. biomechanical pancreas insulin-pump Adobe Systems 13 Retinal implant www.nmi.de/deutsch/ showprj.php3?id=3&typ=1 Retinal Implant 46 MPDA – micro-photo-diode-array Such devices are in clinical testing. They should enable basic spatial orientation. Adobe Systems 14 Cochlear implant The electronic cochlear implants can partly replace the Corti's organ, mainly in children which have intact auditory nerve. It is an electrode system implanted into cochlea, which can stimulate the nerve by impulses generated in the so-called speech-processor. ear implant diagram http://www.accessexcellence.org/AB/BA/biochip3.html Adobe Systems 15 Hip joint substitution http://www.orthogastonia.com/patient_ed/html_pages/hip/hip_hemiarthrooplasty.html Hip or other joint substitutions are made of combinations of plastics and ceramics or titanium and its alloys. Titanium surface is porous, which enables the bone to grow inside the implant surface - lowering need of bone cement. Adobe Systems 16 Acetabular cup (hip joint socket) placement Robots in orthopaedic surgery. The endoprosthesis must be positioned (oriented) with great angular precision. Výsledek obrázku pro knee surgery robot Adobe Systems Knee joint substitution 17 Knee joint replacement prosthesis Adobe Systems 18 Ankle joint http://www.orthogastonia.com/patient_ed/html_pages/ankle/ankle_arthroplasty.html Adobe Systems 19 Elbow and shoulder joint substitution http://www.orthogastonia.com/patient-ed.html 20 Joints of thumb and fingers http://www.orthogastonia.com/patient_ed.html hand_cmc_arthroplasty_intro01 CMC = carpometacarpal Adobe Systems 21 Bioprosthesis of hand – emerging reality 1.Electrode on efferent nerve; 2.Electrode on afferent nerve; 3.Implanted part for recording of nervous activity and nerve stimulation; 4.Efferent telemetric connection; 5.Afferent telemetric connection; 6.Bionic hand; 7.sensors; 8.Decoder of patient’s intentions and control of prosthesis; 9.Unit mediating the signals of sensors to the brain. 10.Subsystems 8-9 will be outside body but easy to carry. schema http://www-arts.sssup.it/research/projects/CyberHand/default.htm 22 Dental prostheses Removable upper prosthesis casi_c2 prothese_adjointe_verte_4 removable_partial_denture Partial prosthesis Preparation of the bed for total fixed dentition substitution Adobe Systems 23 Penile endoprosthesis implant Adobe Systems runaway cartoons, runaway cartoon, runaway picture, runaway pictures, runaway image, runaway images, runaway illustration, runaway illustrations Author: Vojtěch Mornstein Content collaboration and language revision: Carmel J. 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