HIGH-TECHNOLOGY MEDICINE By: Richard P. Brennan Summarized by tfy2 agulto group Presymptomic Diagnosis 1.

Presymptomic medicine- spots disorders or potential problems before they are life threatening 2. Examples of recent developments in this field: Highly accurate lab tests based on the bodys natural immunological system that pinpoints specific disease markers that were undetectable a few years ago. Multisample instruments offer fast, low-cost body fluid analyses Genetic research allows early clues to severe fetal disorders Life-style Assessment Programs 1. Lifestyle assessment programs permit the early evaluation of patients who are especially prone to a particular disease. 2. Process: Through branching algorithm, the computer takes the individual through a lengthy dialog about health habits. Then the computer prints out a prediction of life expectancy based on life-style analysis and other data. 3. Also predicts what effect specific changes in life-style will have in terms of life expectancy. Newest Diagnostic Techniques and Instruments For Lung Cancer Detection 1. Fluorescence Bronchoscope Reveal lung tumors while they are still small and operable, six months to a year earlier than can be seen now Technician injects the patient with a dye that is absorbed by malignant cells over a 3day period The bronchoscope is inserted into the lung and the tissues are illuminated with ultraviolet light from a krypton-ion laser The process is invasive. It involves the insertion of the bronchoscope and the injection of the dye. For Breast Cancer Detection 1. Self-examination-said to be the most efficient means of early detection of breast cancer. 2. Mammograph Mammography- low dosage x-rays of the breasts that detect tumors too small to be felt by hand Recommended once every two years for all high-risk women between the ages of 35 and 50. 3. Thermograph This device detects the greater infrared radiation of tumors compared to normal tissue. The device consists of two fiber pads inlaid with rows of heat-sensitive dots. The pads are applied to the breast for 15 minutes, and then examined. For Detecting Birth Defects 1. Amniocentesis The procedure is usually done during the 16th or 17th week of pregnancy Ultrasound examination is made to locate the position of the fetus in the womb. Fluid is withdrawn by needle. Fluid is analyzed for a number of proteins and enzymes- chromosomal analysis can reveal any genetic abnormalities. Imaging Technology CT or CAT Scanners 1. CT- Computerized Technology 2. CAT- Computerized Axial Tomography Using a thin, fan-shaped x-ray beam, it produces a cross-sectional view of tissues within the human body. It is also able to view a slice of the human body from many angles by rapidly revolving an x-ray tube around the patient. Detectors on the opposite side from the x-ray tube record what the scanner sees, and transmits this information to a computer, which reassembles the data into thin cross-sectional slices. 3. Purpose CAT Scanners: Assess composition of internal structures, discrimination between fat, fluid, and gas Show the shape and size of various organs and lesions, even the very small ones Detect and diagnose conditions Observe effects of therapy and follow up on the results of surgery. 4. Purpose of 3-D CAT images:

 Stimulate the skin, muscle and bones surface that are encountered during surgery. Evaluate brain tumors, head and neck malignancies, spine-injuries, and pelvic fractures Reduces operative time and improves surgical results Sonography or Ultrasound Uses sound waves to look within the body A piezoelectric or pressure-sensitive crystal is used to convert electric pulses into vibrations that penetrate the body, strike the organs within, and reflect back to the surface, where the crystal functions as a receiver. Time delays of these returning signals sketch the targets location, size, shape, and even texture for display on a screen. It obviates the need for CAT scanning and spares the patient from exposure to the mild radiation of other diagnostic techniques. The only body scanning technique recommended for pregnant women For examination of the breast, heart, liver, and gallbladder Digital Subtraction Angiography (DSA) 1. It is an imaging technique that produces clear views of flowing blood or its blockage in narrowed vessels 2. Digital- means numerical 3. Angiography- refers to blood vessel imaging A fluoroscopic image is made of the body area under study. Then that image is stored in the memory of a computer. The information is digitized- that is, the image is divided into a grid of pixels A contrasting dye containing iodine that is opaque to x-rays is injected into the patient The computer then subtracts image one from image two. The DSA detects constrictions and measures the rate at which blood diffuses back into the heart muscles, giving the physicians a good indication of whether hear attack is likely to occur. Positron Emission Tomography or PET 1. PET provides metabolic portraits that reveal the rate at which abnormal and healthy tissue consume biochemicals 2. PET allows observation of changes in brain chemistry after a stroke of the biochemical abnormalities disorders such as Alzheimers disease, Parkinsons disease or schizophrenia. 3. Permits observation of damage to the heart following a heart attack. 4. Tomography- comes from the word tomas, meaning a cutting of a section and graph meaning write. It involves tracing the action of radioactive substance into the human body, the radioactive substance used in PET scanners must be produced in a cyclotron located close to the PET scanner. 5. Cyclotron- an accelerator in which particles are propelled in spiral paths by the use of magnetic fields The patient inhales or is injected with a small amount of radioactive material and is then positioned in the scanning device. The radioactive material emits positrons wherever it flows. The positrons collide with 3 electrons, and the two destroy each other, releasing gamma rays The gamma rays are detected by a ring of crystals around the area being tested, causing the crystals to light up A computer records the location of each flash and plots the source of radiation, translating that data into an image. Magnetic Resonance imaging (MRI) or Nuclear Magnetic Resonance (NMR) 1. It consists of a huge electromagnet, radio frequency generator, and computer for evaluation. 2. The room must be completely insulated from external radio waves. 3. Advantages of MRI over CAT: CAT scanners use radiation that, although at a low level can be a risk For certain parts of the body covered by thick bone material, such as brain areas, MRI works better than CAT No injections are necessary with MRI 4. Process The MRI scanner surrounds the body with powerful electromagnets supercooled by liquid helium. When the MRI magnets are turned on, the nuclei of the hydrogen atoms in the patients body line themselves up with the field. When the radio waves of a certain wavelength are aimed at the body, the hydrogen nuclei realign themselves against the magnetic field. When the radio waves are turned off, the nuclei flip back around to their original position. The flipping emits waves that are detected by the MRI receivers and are then used to create a computer-generated image. 5. Purpose: A sensitive diagnostic tool for cancer

6.

For measuring blood-flow rates from specific locations in the brain in order to identify stroke-prone patients Effect of drugs on the brain can also be detected. The major advantage of the MRI over other scanning devices is that it combines the relative harmlessness of ultrasonics with the high-resolution imagery of CAT and PET scans.

Medical Lasers Laser- an acronym for Light Amplification by Stimulated Emission of Radiation - a means of making pure or coherent light - consists of a glass rod or tube filled with gas - when the laser is pumped with energy in a variety of ways, electrons in the gas are excited into higher energy states - the high release of energy electrons release their extra energy as light. That light is amplified as it bounces back and forth between two mirrors Types of Lasers 1. Conventional lasers- use various substances such as carbon dioxide or even gold produces differing wavelengths of laser light. 2. Free-electron laser- uses a magnetically controlled electron beam, similar to the beam in a television picture tube to produce a range of wavelengths. 20 times more efficient than previous laser machines. More powerful than conventional laser beams Laser Therapy Argon Gas Laser- is used to produce a wavelength that is absorbed by red pigment. It can pass harmlessly thorough the eyes transparent lens and the clear fluid of the inner eye. But when the beam hits the retina, the laser causes coagulation of the blood vessels, fusing adjacent tissues. This means the eye surgeon can spot weld detached retinas. Excimer Laser- sculpts the cornea- the transparent front outside coating the eye- correcting nearsightedness, farsightedness, and astigmatism. Its ultraviolet beam breaks chemical bonds and allows cells to be washed away without damaging surrounding tissue. Doctors hope that this approach will let them reshape the curve of the cornea without scarring. The shape of the cornea determines how light is focused on the retina in the eye. Laser Angioplasty Balloon angioplasty works best when a blood vessel is only partially blocked A new procedure incorporates both the balloon and a tiny laser and its designed to be used on totally blocked vessels. In this procedure, the laser beam is intended to vaporize the plaque, cutting a channel. Then the deflated balloon is threaded through the channel and inflated to push the remaining plaque against the vessel walls- approved for blood-vessel blockages in the legs. Bionics Bioengineers use a reference bank of implant designs, special software, and a computer terminal to design joints to meet a specific patients needs. Artificial legs that use electromechanical knees controlled by the will of the wearer are now being experimented on. This is made possible by the electrodes that pick up signals from the brain and then passed onto the remaining muscles, enabling the leg to respond naturally Fiber Optics Endoscopy- viewing internal organs of the body with an instrument is now increasingly used for treatment Example of therapeutic use of fiber optics is the removal of colon polyps and the extraction of foreign objects from the stomach and esophagus- fish bones, pins, etc. Microsurgery Today, surgeons can use binocular operating microscopes powerful enough to provide a 3dimensional view of the field of operation at magnifications ranging up to 40 times. Example of tools of microsurgery: miniature probes, hooks, clips, and suture needles First to employ microsurgery were ophthalmologists for delicate eye operations This technique greatly increases the chances of success in any kind of implantation surgery. Transplants Transplantation of Brain Tissue Transplantation of a portion of brain tissue is a promising field of the treatment of Parkinsons disease and other neurogenerative problems Because most of the symptoms of Parkinsons result from the loss of certain neurons in the brain, and because of the limitations of the drug levodopa as a substitute for that loss, researchers have begun to consider replacing the lost tissue with transplant Transplantation of Human Fetal Tissue Cure to Parkinsons: Parkinsons involves the slow degeneration of brain cells that secrete dopamine, a movement-coordinating chemical. By transplanting fetal cells able to produce

dopamine, medical researchers have succeeded in relieving the symptoms of Parkinsons. Use of human fetal tissue however, raises ethical issues. A variety of harmful microorganisms have been associated with spontaneous abortions. For these reasons, tissue from spontaneously aborted fetuses is not recommended for transplantation to human subjects. Using a Patients Own Tissue for Transplants Using a patients own tissue avoids problems of host graft rejection and the necessity for using drugs to suppress rejection. However, these adult adrenal autografts do not reverse parkinsonian symptoms as well as do fetal cell grafts Use of Animal Tissue- It is possible that monkey fetal cell could be altered for use in humans. Donor brain tissue might also come from baboons or chimpanzees. Interspecies grafts have worked between mice and rats. Synthesized Tissue- In the near future, procedures will be developed using purified, enriched, or genetically engineered cells that will produce the specific results desired. Design Drugs for the Brain- Each transmitter fits into a special receptor on the surface of the brain cell. By designing a drug for a specific receptor only, undesirable effects can be avoided. Examples: Drugs that increase attention span, improve memory, and prevent suicidal depressions THE FUTURE OF MEDICINE By Alexandra Wyke Diagnose easily but little help in the treatment Modern medicine- multi-trillion dollar business Antibiotic changed all these surprisingly, little or no evidence at all that modern doctors, pills, or surgery have improved peoples overall state of health Americans life expectancy o 1940-63- due to increased wealth, better sanitation, nutrition, housing, and surprisingly REFRIGERATORS! (not modern medicine (science)) TB- third world country disease - started to appear in Europe and America because of careless use of antibiotics allowed the bacteria to an opportunity to evolve drug-resistant strains AIDS, Cancer, Heart Disease appeared after the middle ages Healthcare- one of the worlds largest industries VISIONS: Surgical robots that operate with higher precision Doctors, nurses, hospitals and manufacturers will all be linked through network of PCs, phones, fibers, satellite link-ups Short-lived long lasting treatment o Example: Heart attack- can only remove blood clot but this does not assure the patient of full recovery Long ago, anaesthetics did not exist David Vandemater- chief operating officer COLUMBIA HEALTHCARE, a hospital chain in Louiseville, Kentucky Strategy of Columbia is to establish a provider network, where we can offer anything the patient needs, be it, diagnoses or skilled nursing facilities not just hospitals. Merck, the worlds biggest drug company

AUTOMATIC HEALTHCARE- in the medical world, communication means doctors writing (often illegibly) on scraps of paper that are stored in filing cabinets to be forgotten or lost Modern methods of compressing huge data will permit pieces of information such as x-rays or even moving pictures be sent through fiver-optic cables High definition TV can provide imagery good enough for dignoses (difference in color of tone) POOR MEDICAL RECORD E-medical Record System- EDS & Harvard Community Health Plan installed a mini-computer at a health center in Burlington, Massachusetts Linda Tetzlaff From IBMs Thomas J. Watson Research Center Is developing a system for parents who look after young children with leukemia Computer doctor that answers questions such as What to do with a seizure? or even What is a seizure?

SAVING MONEY 1993- Regenstrief Institution (University of Indiana) published the results of a trial that produced savings of over $800 per hospital in patient when doctors used computers to order test or to receive reminders Figures show that a hospital can save $3M a year Saving across the whole country could approach billions of dollars for just one computerized procedure A TRIP TO THE THEATER Surgeons enter holes on patients bodies to repair whats inside Could do surgery with minimal damage to outside (physiology) Dr. Ferenc Jalesz (Brigham Womens Hospital & Harvard Medical School) GE, IBM, Sun Microsystems, Kodak, Zeiss, & Thinking Machines Corporation are his sponsors All of which could benefit a lot from his project SEEING LIKE SUPERMAN Precision images could help develop an awful lot for a few lapse in measurement (mm) can make a difference between missing and hitting a blood vessel MRI (Magnetic Resonance Imaging) Capsule cameras probe the body (discovery channel) FUTURE FIELDS OF PLENTY By Michael Zey THE FOOD SUPPLY REVOLUTION

Macroindustrial Era = emerging future Green Revolution

5 Major Factors Hybridization of corn ninefold increase in fertilizer use between 1950 and 1984 near tripling irrigated areas in the same period spread of new high-yield wheat and rice seeds in 3rd world countries the use of chemical insecticides, herbicides, rodenticides, and fungicides

Much of the remaining hunger and malnutrition results more from wars and governmental policies

than agricultural shortfalls HOW LARGE A POPULATION CAN THE EARTH SUPPORT population = expected to grow 8.5 to 11 billion sometime in the next century THE EXPANDING LAND BASE key factor in food supply revolution: ever-growing agricultural land base humanity is "greening the desert." ex. Indira Gandhi Canal was launched in 1958 to bring lifesustaining water to the northwestern India state of Rajasthan, it now helps to irrigate more than 1.5 million acres of once-arid land. halophytes = plethora of hardy plants that thrive on salt Saline agriculture = salty soil and water Factors causing the land area available for farming to decrease Growth of cities Increased populations and desertification Gradual expansion of deserts into previously arable land THE BIOTECHNOLOGICAL BREAKTHROUGH Impact of Biotechnology on Agriculture Obliterate hunger and even to force to reconceptualize issues like scarcity and abundance Disease and drought resistant crops Crops that are tolerant to to herbicides and salt and also immune to attacks of insects. Antisense RNA and DNA = allow products to retain their unripened flavor and enjoy a longer shelf life > may also decrease level of natural toxicants. BST = borine sematotropin = an additive that increases cow's milk production by up to 10% Calgene and Mosanto are the companies that are planning to introduce genetically improved tomatoes with extended shelf life. Biotech = prepared to attack problems that are currently controlled by chemical pesticides. The market of pesticides is expected to grow to an astonishing $10 billion by 2000 COMING SOON: CELL AND FOOD FACTORIES Washington State University = a team of research chemical engineers has set up clusters of plants and animal cells which are suspended and agitated within bioreactors, i.e. Tank-like fermenters in a liquid solution of carbohydrates and salts

cell factories = newest biotechnological innovation Disney's World Epcot Center houses the Plant Biotechnology Laboratory = one of US' major
public showcases of plant biotechnology

Tissue culture technology has been successfully applied to strawberry plants, pineapple, trees,
carrots, potatoes, and peanuts

hydroponics = the growing plants in nutrient solution for deserts and space colonization endeavor Food factories callus = a mound of undifferentiated cells. Every single cell in the callus has the genetic information
to become one whole plant

Scientist Brent Tisserat = demonstrated that one could create food in vitro Stumbling block in establishing such factories is the availability of cheap and abundant "feed stock,"
i.e. The nutrition that will help the grain and fruit grow.

David D. Ellis = a University of Wisconsin horticulturist successfully inserted foreign genes into the
embryos of white spruce. IMPROVING THE ANIMAL KINGDOM Embryo transfer technology = splitting of embryo at very early stages, we can now produce genetically superior animals. A more daring biotechnological technique is the process of cloning large numbers of identical animals from a single embryo. BIOTECHNOLOGY IN THE THIRD WORLD Incorporation of biotechnology into its agricultural programs Third World countries' foreign debt impede their entrance into the Macroindustrial world structure IMPLICATIONS FOR THE HUMAN SPECIES Eliminating hunger and malnutrition from the face of the planet. Species' members will live longer, healthier lives Agriculture will be more an engineering project than a family-run rural business. Agricultural and materials revolution may spell the beginning of the end of poverty. ONLY THE BEGINNING encouraging a world economic system that ensures that the species as a whole participates in the benefits. Culture must support the continued expansion of the knowledge resource, and talent base. NEEDED: ANOTHER GREEN REVOLUTION The Third World as a whole needs another green revolution. The global society, at the dawn of the Macroindustrial Era; has the technology and resources to help the world feed itself and meets the growing needs of a growing population. BIOTECH AGRICULTURE Paul Kennedy Agricultural Revolution- enhanced the power in the earth, which started in England. Population increase lead to the problem of widespread malnutrition 1980s- Croplands were eliminated to make way for roads & buildings. This caused soil erosion & degradation bringing about the abandonment of farmlands and careless irrigation led to widespread salinization of the soil. To prevent malnutrition & starvation increase, the remaining farmlands increased their productivity. 1950-1984- food production rose faster. World grain harvests rose 2.6 times Production of root crops, meat, milk, fish, fruits, and vegetables also expanded in response to worldwide demand for food caused population growth and enhanced standards of living. Millions of additional acres were cultivated, and newer machines, more fertilizer, better irrigation and crop rotation were introduced. Green Revolution in Asia Improvement of mechanization & fertilization Great advances caused by biotechnological breeding of newer strains of plants. New hybrid strains rice were more durable, more resistant to diseases and pests and produced higher yields. International Agricultural Research Centers- international research and applied agricultural science. Miracle Rice- said to have averted famines, weaned poor countries off dependence on imported food, and provided political stability. Had far greater impact than Britains Agricultural Revolution. 1980s Pace of increase in global agricultural production slowed considerably, because of intense droughts in 1988. Global production of root crops peaked in 1984 but has then declined because of fertilizer overuse, attacks of new diseases, deterioration of soil quality, and less suitable land available for further planting. Proposed solutions:

Increase in food aid. Only, it will increase the dependency of poorer peoples upon richer countries, whereas a failure to supply such aid could intensify migration out of fooddeficit countries. To augment the amount of croplands. But where will additional land come from? Additional croplands would only come at the expense of forests accelerating global warming. Increase the efficiency of farmers in poorer countries with better training and instruction, improved access to markets, more skillful handling of seeds, better crops, fertilizers, and farm machinery, and ecologically sound agroforestry.

Biotechnology Biotechnology- any technique that uses living organisms or processes to make or modify products, to improve plants or animals, or to develop microorganisms for specific uses. Scientists can isolate, clone, and study the structure of the gene and seek to understand its relationship to the processes of living thing. Genetic Engineers are now able to insert into the DNA of a living cell a new gene to improve the organisms strength, size, or resistance. Biotech Revolution in Agriculture Insertion of bovine growth hormone into cattle to increase their milk output. Genetic alterations of the reproductive cells of fish, poultry, sheep, and pigs. Creating plants that are resistant to viruses or insects Engineering crops that are impervious to certain weedkillers, allowing farmers to spray indiscriminately. Creating faster-growing tropical crops like bamboo. Experimentations on producing plants that would fix their own nitrogen, thereby producing the need for chemical-based nitrogen. Disadvantages of Biotech agriculture: Health issues-Hogs into which growth hormones have been inserted are subject to gastric ulcers, arthritis, dermatitis, and other diseases, making them possibly dangerous for human consumption. Environmental issues- Herbicide- resistant crops could increase the indiscriminate spraying of designer herbicides, which will then be carried away in the atmosphere or water drainage system. Danger in increasing genetic uniformity of key plants- identical crops are vulnerable to a single pest or disease, increasing the risk of costly crop failure. Encouragement of the evasion of fundamental ecological reforms- farmers would resort to the answers the scientists will provide rather than using their resources to solve them. Global effects of Biotech Agriculture: o Offers new products and improve ways of creating existing ones o Opens new markets o Reduces the costs of many manufacturers and services o Alter pattern of international trade o Change the way national economies are structured Three trading blocs in biotech farming o Japan o United States o European Community. Two Biotchnological regimes o First regime encourages genetic engineering o Second restricts genetic engineering