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Ultrasound
Published in William Y. Song, Kari Tanderup, Bradley R. Pieters, Emerging Technologies in Brachytherapy, 2017
Maximilian P. Schmid, Luc Beaulieu, Nicole Nesvacil, Bradley R. Pieters, Arnoud W. Postema, Stefan G. Schalk, Frank-André Siebert, Hessel Wijkstra
Based on the concept behind the breast biopsy system, De Jean et al. designed a computer-controlled motorized 3DUS guidance system for breast high-dose rate (HDR) brachytherapy (De Jean et al., 2009). Figure 14.14 provides an overview of the system, which is based on a standard 2DUS breast probe that is mounted on a motorized probe holder. The particularity of this system is that it was designed as an attachment to a widely used interstitial breast brachytherapy template, the Kuske Template (Elekta Brachytherapy, Veenendaal, The Netherlands). The system was also designed such that the 2DUS probe could be moved to the insertion plane of a needle and to track its insertion in real time without further motion, similar to existing prostate brachytherapy systems (Beaulieu et al., 2007). One important issue in breast brachytherapy is the mobility of this external organ. Moving an US probe on the surface of the breast is likely to induce deformation and displacement. This is avoided in part by the use of an US compatible polymethylpentene (TPX™, Mitsui Chemicals America Inc., Rye Brook, New York, USA) plate. The plate is placed on the breast and the pressure adjusted to minimize the impact at depth. Once set-up, the 2DUS probe is moved on this plate instead of the breast itself. This ensures stability of the organ shape and location.
Mechanical ventilation and extracorporeal membrane oxygenation (ECMO): Bridges to lung transplantation
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
In the 1990s, ECMO was used primarily for graft failure after lung transplantation and only rarely as a bridge to transplantation. According to UNOS data, from 1990 to 2000 only 22 patients were listed for a lung transplant while on ECMO.12 Factors hindering the clinical utility of ECMO included (1) limited membrane performance and durability, (2) membrane plasma leakage, (3) limited performance of the older roller head pumps, and (4) bleeding related to systemic anticoagulation.12,13 More recently, ECMO oxygenators with polymethylpentene (PMP) membranes (Maquet Quadrox) have replaced the older silicone or polypropylene membrane oxygenators. PMP-based membranes not only have superior gas exchange characteristics but can also support ECMO for several weeks without plasma leakage or need for exchange. In addition, newer centrifugal pumps cause less hemolysis than the older roller designs did. Furthermore, increased use of heparin-bonded circuits has decreased the need for aggressive anticoagulation.12–14
Research progress of portable extracorporeal membrane oxygenation
Published in Expert Review of Medical Devices, 2023
Yuansen Chen, Duo Li, Ziquan Liu, Yanqing Liu, Haojun Fan, Shike Hou
The Novalung system (Xenios AG, Germany) is an extracorporeal assisted system that is designed based on pECLA [34]. The size of the system is only 135 mm ×135 mm× 400 mm because of the lack of a blood pump. The system uses polymethylpentene(PMP) membranes to reduce plasma leakages, and it also uses heparin coating technology to optimize blood compatibility and reduce the risk of thrombosis. The short piping of the system allows negligible heat loss and therefore does not require a heater, the preload volume of the entire system is only 240 ml. The system has been shown to be effective in supporting the treatment of patients with acute respiratory failure and severe hypercapnia. Although the limited oxygenation capacity it provides compared to conventional ECMO is not suitable for patients with cardiac insufficiency. However, conventional ECMO requires high operational and nursing staff and may also be limited by the available equipment resources. The Novalung system has a potentially wide and potential application as a new respiratory-assisted support system and has been used in several scenarios such as the war on terror [35].
Recent advances in extracorporeal life support as a bridge to lung transplantation
Published in Expert Review of Respiratory Medicine, 2018
As with mechanical ventilation, the two leading indications for ECLS initiation are bridge to recovery and bridge to transplant. Substantial improvements in ECLS technology and encouraging results among ARDS patients have led to increasing use of such devices [8–12]. Major advances in ECLS included the development of both heparin-coated circuits and polymethylpentene oxygenator membranes, introduction of centrifugal pumps, dual-lumen cannulas and miniaturized systems allowing easier transfer of patients [13]). Collectively, these advances may also help explain the increasing use of ECLS as a bridging strategy to lung transplantation [14,15].
Predicting successful weaning in patients treated with venovenous extracorporeal membrane oxygenation
Published in Alexandria Journal of Medicine, 2020
Tayseer M. Zayton, Ehab M. El-Reweny, Haitham M. Tammam, Kareem M. Gharbeya
The ECMO circuit for associate adult patient is typically very compact, with some flexibility for ICU patients transportation, mobilization, and general care. it always consists of an inflow cannula (drainage cannula), a circuit tubing which is made of polyvinyl chloride (PVC), a centrifugal pump, a polymethylpentene (PMP) membrane oxygenator, and a return cannula that transports arterialized blood (reemission cannula). Continuous renal replacement therapy could also be connected on the ECMO system [3].