Productivity turnaround. - European Hospital

News . . . . . . . . . . . . . . . . . . 1–6Cardiologysupplement . . . . . . . . . . . . 7–17Medica 2007 forecast . . . . . . . . . . . . . . . . . 19IT & telemed . . . . . . . . . 20–21Respiratorymedicine . . . . . . . . . . . . . 22–23Wound care . . . . . . . . . . 24–25Lab & pharma . . . . . . . . . . . 26Surgery . . . . . . . . . . . . . . . . . 27Russian pages . . . . . . . . 28–31

contents

V O L 1 6 I S S U E 4 / 0 7 A U G U S T / S E P T E M B E R 2 0 0 7

7–17 Cardiology

● Nanoscalecontrast agents

● 1st AF monitoringdevice implant

● Stem cells aidcardiac repair

22–23Respiratory med

● Internationalstandards for TB care

● Portable devicemeasures StO2

● Monitoring asthmaand COPD

1-6News

● Innovations inradiology

● Game to aidepidemiologists?

● Needle-freedevice awarded

A pilot project begun in Februaryby the Ministry of Health and theNational Health Insurance Fund(NHIF) has resulted in Bulgariaissuing its first electronic medicalcards. The pilot project is run by the international eHealth specialistICW* in partnership with the firmsCisco and Kontrax.From September 1,000 inhabitantsof the towns of Slivnitza andAldomirovzi (both about 30kmfrom Sofia) will receive personalelectronic medical cards (EMCs).These will predominantly be givento chronically ill patients by theirgeneral practitioners (GPs) duringregular surgery visits. Patients par-ticipating in this project were nomi-nated by the GPs.

Each EHC is fitted with a micro-processor chip that stores thepatient’s personal data, issue andcard number, and a security certifi-cate; data that enables an automaticcheck of the patient’s insurance sta-tus and GP allocation.

Electronic receipts for drugs paidfor by the Bulgarian medical insur-ance are also stored on the chip.

Currently the system is being test-ed in a field project and participat-ing doctors and chemists are receiv-ing training from specialists at ICW

and Kontrax. Afterthese tests and training ses-sions the pilot project will beginand the first Bulgarian electronicprescriptions will be issued.

In the first six months after theofficial start of the project the infra-structure was developed along withspecific software: All doctors andchemists in Slivnitza and the NHIFwere linked to a reliable, secureprivate network. Cisco supplied thenetworking equipment, firewallsand IP telephones.

ICW, main contractor and sys-tems integrator for the project haveadapted their software solutions,which have already been used inGermany and Austria, to the spe-cific requirements of the Bulgarianhealthcare system. The ICW soft-ware development kit (SDK) seam-lessly links the medical card systemwith the software used in surgeriesand pharmacies. The Kontrax soft-ware Hippocrates and the pharmacy

systems Pharmacy Expert suppliedby Libra Inc. and Pharma Star, sup-plied by AS Systeme, can now com-municate with one another throughthe ICW eHealth- infrastructuresolutions.

The pilot project for the Bulga-rian electronic medical card wasinitiated by the Bulgarian Ministryof Health and the NHIF. ICW wasappointed for its implementation inco-operation with Cisco andKontrax. * InterComponentWare AG (ICW) isan international eHealth specialistwith sites in Germany, Austria,Switzerland, the USA and Bulgaria

Diuretic pill extends lifeUK & France – The Hypertension in theVery Elderly Trial (HYVET), the biggest glob-al clinical trial to assess the benefits of low-ering blood pressure in patients aged 80+,was halted in July, two years before itsscheduled completion in 2009. ChristopherJ Bulpitt MD, the trial’s PrincipalInvestigator and Professor Emeritus of theCare of the Elderly Department at ImperialCollege London, said the interim findingsindicated that an inexpensive, low dosediuretic (indapamide 1.5 mg sustainedrelease) and if needed, an additional ACEinhibitor (perindopril), taken daily, reducedthe number of strokes and mortality at astatistically significant level.

3,845 patients in seven countries(Bulgaria, China, Finland, Romania, theRussian Federation, Tunisia and the UK) par-ticipated. The trial was designed to deter-mine whether a 35% difference occurredbetween a placebo and active treatment.Secondary outcome measures includedtotal mortality, cardiovascular mortality, car-diac mortality, stroke mortality and skeletalfracture. All patients in the double-blind,randomised, placebo-controlled trial, begunin 2001, are being seen for a final visit.Participants receiving a placebo will beoffered the option of switching to activeindapamide 1.5 mg SR-based antihyperten-sive treatment.

Results from the HYVET trial, which wasfunded by the British Heart Foundation andthe Institut de Recherches InternationaleServier, in France, and co-ordinated by sci-entists at Imperial College London, areexpected to be published in a peer-reviewedjournal and presented at a major medicalmeeting in spring 2008.Report: Cynthia E Keen

Leaders launch a newglobal health partnership

Richer countries urgedto fast-track Millennium

Development Goalsfor healthcare

UK & Germany – An Internat-ional Health Partnership is to belaunched (5 September) to bringtogether major donor countries,as well as key internationalagencies such as the World Bankand the World HealthOrganisation, to hasten theMillennium Development Goals(MDGs) that aim to reduceinfant and maternal mortalityand tackle HIV/AIDS, polio,measles and many other diseases.

The new partnership followstalks at 10 Downing Streetbetween the UK’s new PrimeMinister Gordon Brown andGerman Chancellor AngelaMerkel, who later jointlyannounced that addressinghealthcare and aid provision wasnow a ‘development emergency’.

Speaking at the United Nationsin June, Prime Minister Brownhad urged the most developedcountries to get back on trackwith meeting their jointly agreedMillennium Development Goals

(MDGs), which were establishedby the UN back in September2000. These include specificcommitments, such as eradicatingextreme poverty and achievinguniversal primary education – aimsto be met by 2015.

For her part, earlier this yearChancellor Merkel had led the G8summit, when the world’s richestnations promised to honour

financial commitments andimprove the co-ordination of aidwith national health plans ofrecipient countries.

The two leaders pointed out thatthe MDGs that focus on healthcarewere the ‘least likely to be met’ bythe agreed target date of 2015,adding that an ‘improvedapproach’ was needed. This wouldentail strengthening of ‘weaksystems’ that suffer a lack ofworkers and clinics, and improvingco-ordination of ‘complex’ and‘fragmented health provision’.

Following their meeting, PrimeMinister Brown said: ‘We re-affirmour commitment made at the G8and the EU to provide thefinancing needed to meet ourhealth commitments through theestablished institutions andmechanisms. In this context, thereplenishment of the Global Fundwill be a key step. We will alsoexplore innovative financingmechanisms to meet thesecommitments.’

They two leaders stated: ‘We seethis [the new partnership] as acritical step in our call for aninternational mobilisation of effortto achieve the MDGs that willbuild year on year until 2015. Ourefforts must bring together theprivate sector, NGOs, faithgroups, international agencies andgovernments in a new partnershipto reduce poverty, improve healthand provide opportunities for thepoor across the world.’

During a press briefing,Chancellor Merkel added: ‘Westrongly welcome the Britishinitiative, which is aiming at us,combined with the MillenniumDevelopment Goals, and that isthe health initiative that the Britishhave proposed. We believe that itindeed offers us an opportunity tohelp us efficiently work towardsour compliance with thoseMillennium Development Goals. Iwill be travelling to Africa verysoon and I will do my best tocanvas for their support.’

Bulgaria issues first electronic medical cardsProductivityturn around.

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T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K

State-of-the-arttreatment at Charité

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The courses

Clinical application: Aimed primarily at radiologists,specialists, technicians, nurses and carers interested intraining in clinical applications. The Health Care MBA Programme: For managers, doctors,experts and healthcare investors, this is offered jointlywith the Nations Health Career School of Managementin Frankfurt/Main. Biomedical engineering: This enables researchers,professors and students to pursue concrete technicalquestions and development projects. Service support: Practical training for specialists inmagnetic resonance, computer tomography andultrasound technology. Forums: The Technology Academy offers a number offorums for researchers, students, patients etc. Enrolment and full details:www.hitachi-medical-systems.com www.hitachi-medical-systems.de

Hitachi Medical Systems has opened itsEuropean Technology Academy in Dussel-dorf, to provide ‘360° Educational Pro-gramme’ of training courses and informationservices for doctors, health service employees,scientists, patients, managers and engineers.Whilst handling the regular training of theHitachi Medical Systems Teams, the compa-ny reports that it is also making a contribu-

tion to the German research and educational landscape. The Japanese firm Hitachi Medical Corporation develops

advanced medical imaging systems that are distributed byHitachi Medical Systems Europe Holding AG and nationalsubsidiaries, distributors and partners. The product rangeincludes systems using ultrasound, MRT, computer tomogra-phy and optical topography. The company points out thatGermany is ranked second after the USA for innovationpotential in medical technology, and that specialist trainingopportunities are important to secure this position for thefuture. ‘The Hitachi Medical Systems Technology Academy in Dusseldorf is an impetus for innovation and a contributionto better national health care,’ explained Dr Marco Dolci,President and CEO of Hitachi Medical Systems EuropeHolding AG, based in Zug, Switzerland.

With a string of highly qualified specialist lecturers andadvanced infrastructure, the Academy promises to providetraining in a range of medical technology disciplines to thehighest standards.

2 EUROPEAN HOSPITAL Vol 17 Issue 4/07

N E W S

NUTRITION AND HEALTHDetermining body weight in the elderlyElderly people lose their physical reserves and are thus more susceptible todiseases. Very often not only one but several organs are affected.Consequently, prophylactic measures such as control of body weight todetermine the patient’s nutritional status become crucial. Control of bodyweight can reveal, for example, whether a patient is underweight, and thusit plays a major role in fending off malnutrition. Fluid balance can also bemonitored by body weight.

Cardiovascular conditions such as hyper- or hypotension, or cardiac insuf-ficiency, can cause severe disequilibrium. However, many otherwise healthyelderly people are also insecure when walking or have problems co-ordi-nating movements. In such cases standard weighing scales are not suitable.Products are needed that take into account such problems and offer solu-tions – such as the platform scales manufactured by seca gmbh & co.

In the seca product portfolio are scales with handrails, which make it eas-ier for insecure patients to step on and off the platform. In addition, the gen-erous dimensions of the seca platform scales allow for assisted weighing.Usually, the nurse steps on the scales first, so that his or her weight is reg-istered as tare to be deducted later. Then the patient steps onto the plat-form, assisted by the nurse. When the patient steps off, only his or herweight is displayed.

With 300 kg capacity, the seca scales can hold considerable weight.For people who find it difficult or impossible to stand upright during

weighing, the company provides chair or wheelchair scales: a chair caneither be placed on the extremely flat platform, or a wheelchair or rollatorcan be rolled onto the platform. Side barriers ensure maximum safety, secapoints out. The weight of chair, wheelchair or rollator is tared and only thepatient’s precise weight is displayed.

Austria – 206 tips for administrative reforms, given by the AustrianCourt of Audit to the finance in August, have created a bit of a stir.Almost half of the envisaged total savings potential of €4-5 billion isexpected to result from a reform of the healthcare sector.

Simply by aligning the number of hospital beds with the Europeanaverage, a considerable number of expensive acute beds could besaved and around €2.9 billion could be spent on out-patient care andsurgeries, rather than on in-patient care. However, currently thestructural conditions for this implementation are not ready and needto be created.

The number of acute beds in Austria has been continuouslyreduced over the years. However, with 6.1 beds per 1,000 people it isstill high compared with the European average: 3.9 beds.

The Court of Audit is basically demanding a reorganisation ofcompetencies in healthcare and hospital funding. One suggestion is todetermine a fixed proportion of the gross domestic product (GDP) tobe spent on healthcare (currently 10.2% including nursing). TheCourt of Audit has also targeted regulations on medical fees andspecial charges for potential savings.

The response from the Department of Health and representativesfrom the medical world has been partly positive, partly negative andpartly acrimonious. Shifting the provision of medical services isunlikely to result in huge savings and would at best help to containcosts. Nobody can quite envisage a savings potential of around €2.9billion whilst maintaining the quality of medical services. However,the approach taken by the Court of Audit has certainly resulted in adebate on principles.

A new concept for 24-hour careA fierce debate around the illegal employment of foreign careworkers in Austria resulted in a new concept for 24-hour care.

An estimated 40,000 nursing assistants, most from EasternEuropean countries, were being employed illegally in Austria. SinceJuly 2007, the country has had a new, controversial concept for 24-hour care developed by the Ministry of Social Affairs. This systemallocates care services to those who need them, or to their relatives,from a support fund for the disabled.

This aid can be worth up to €800 per carer for those in regularemployment, or up to €225 for contractors (self-employed carers).The carer can either be directly employed by the person in need ofcare or their relative, can be a contractor working for somebodyentitled to that care, or may be employed by a charitableorganisation. By 1 July 2008, at the latest, carers will have todemonstrate that they hold qualifications in the theory of care tomaintain quality assurance. Applicants must be able to prove thatthey are entitled to a level three (or higher) nursing allowance.Applicants’ incomes are taken into consideration and the incomelimit is €2,500 net a month, excluding payments such as nursingallowance, special grants, family allowances, child benefits andhousing benefit. This upper income limit increases by €400 for eachdependant, and by €600 for each disabled dependant. Assets up to acash value of €5,000, along with the value of the home if this is themain residence for the disabled person claiming, are excluded fromthe calculations.

This rule is applicable until 31st December 2007 and there arecurrently negotiations with the individual Austrian Länder to developa system that can be implemented after the current system expires.

Cardiac CT angiography (CTA) per-formed after coronary artery bypassgrafting surgery can reveal a highprevalence of unsuspected cardiac andsignificant non-cardiac findings thatmight otherwise be overlooked,according to a study by researchers atthe University of Maryland MedicalCentre, Baltimore (‘Cardiac CTAngiography after Coronary BypassSurgery: Prevalence of IncidentalFindings, Pub: American Journal ofRoentgenology [August. 189:414-419]).

This capability of CTA performedafter major cardiovascular surgery hasthe potential to detect earlier treatablecardiac and non-cardiac complicationsthat are not suspected at the time ofthe surgery or the CTA examination.

This first study of its kind, involving259 postoperative cardiac patients orinpatients at the University of

MediMap is an internet portal that evolved from an EUproject with partners in eight countries. The aim is toencourage an exchange of experience and initiate andfacilitate partnerships and business relationshipsthroughout Europe for scientific organisations andmedical technology companies.

The firm reports that the user can select areas ofmedical technology (product categories) for which he isseeking partners, and the portal produces a visual listpresented as regions marked green. Then the user canzoom in to refine his regional selection, and click againfor a results list that features all the relevant players inthose regions. The list, says MediMap, provides a wealthof information, including company profiles, productsand/or services, as well as graphical information in aseparate PDF file, and contact details.

In another section, organisations not seekingpartnerships can promote and market themselves, or

observe the competition, etc. MediMap points out that it also addresses

universities, research institutions, hospitals andclinics as well as clusters, networks, initiatives,technology centres and incubators, and thecompany adds: ‘Regional development agencies,economic development bodies and similarinstitutions will also come to appreciate MediMapfor the opportunity it offers to intensify anexchange of experience with other regions inEurope via a regional profile they can place on theMediMap platform.’

To use MediMap, registration is required. Twolevels of membership are offered:

Standard (free); Premium (fee: €100-600depending on number of employees). Non-enterprise institutions pay €300.

Standard members can enter a profile of theirorganisation, but without logo or graphics, andthey can only access contact data of searchedprofiles. However, they do have full access tomedical technology profiles of the EU technologytransfer database, MediMap points out.

Premium members enter full profiles, logos, etc.and have unrestricted access to all data. They canalso include specific offers and receive enquiriesabout their products, services, technologies, orsearch for partners, for example EU projects underFP7. ‘They may also choose personalised servicesvia keywords (e.g. new members, new technologicaldevelopments), then they will receive e-mails withthose details,’ MediMap reports.Details: www.medim ap.euContact: Rainer Hagedorn, MediMap Co-ordinatorE-mail: [email protected]

CTA benefits coronary artery bypass graft patients

206 tips tosave money

Maryland Medical, revealed that 20%had at least one potentially significantfinding requiring therapeutic interven-tion or further radiologic evaluation.Without a CTA procedure, necessarytreatment may not have been initiat-ed.

Lead author Jeffrey S Mueller MD,a radiologist currently affiliated with Allegheny General Hospital(Pittsburgh, PA), wrote that the ‘rate ofincidental findings (compared withother peer-review published studies)may be higher because thinner recon-structions were used and IV contrastwas administered’. The retrospectivestudy evaluated patients between10/02 and 3/06.

Dr. Mueller and his colleagues iden-tified 24 patients who had at least onesignificant cardiac finding, 34 who hadat least one significant non-cardiac

finding, and seven who had both. Themost common cardiac findings weremoderate or large pericardial effusions,intracardial thrombus, and substantialparacardiac or mediastinal haemor-rhage. Non-cardiac abnormalitiesincluded pulmonary nodules, pneumo-nia, lobar mucous plugging, and pul-monary embolism. One patient had alung carcinoma.

Among the 259 patients, 40 had aroutine follow-up cardiac CTA in thelate postoperative period (mean 12.7months). Of these, seven patients, or17.5%, were identified with an inci-dental and unsuspected finding.

The researchers strongly recommendthe utilisation of CTA for postoperativein-patients. They caution that the find-ings cannot be applied to patients withonly suspected coronary artery disease.Report: Cynthia E Keen

New Technology Academyopened in Germany

Dusseldorf’s new Technology Academy

Medical Technologies Map ofEuropean Regions and Clusters

Juergen Hahn,Managing Director

REPORTS FROM THE NETHERLANDS, BY MICHIEL BLOEMENDAALN E T H E R L A N D S

EUROPEAN HOSPITAL Vol 17 Issue 4/07 3

N E W S

GERMANYUniversity hospitalfounds internationalconsultancyGermany – The Hamburg-Eppendorf University MedicalCentre (UKE) has founded aconsultancy in a joint venturewith SOLVE ConsultingManagementberatung GmbH and Hellman Worldwide LogisticsGmbH & Co. KG.

Among its offerings the newfirm, named MBConsult andManagement GmbH (UCM), areadvice on the development ofmedical concepts for healthcare;the design and planning ofprocess-oriented infrastructures,and consultations on medicalnecessities, hospital managementas well as education and trainingof medical and administrativestaff.

Aiming ‘to market Germanuniversity medicine globally’, thefirm reports that its first projectsinclude two in Kuwait -developing a medical concept fora children´s hospital and themanagement of a preventioncentre, and another in Tirana,Albania – managing cardiacradiology centre.

Furore over increased balloon angioplasty unitsA decision by Ab Klink,Minister of Public Health,Wellbeing and Sports, toincrease the number of balloonangioplasty facilities inhospitals to 30, has promptedthe NVVC – the Dutchcardiologists association – toexpress concern that there willbe too many centres and toofew patients, and specialists willnot be able to maintain thelevel of skills for this procedure.If the minister maintains his

plan to allow hospitals to provideballoon angioplasty withoutcardiologists’ support, then hewill also overlook the advice ofthe National Health Council,which gives almost the samewarning as the NVVC.

The Dutch Association of HeartPatients also commented: ‘Thequality of treatment by balloonangioplasty will without doubtworsen in this way. Theconsequences of these plans couldbe accidents, especially if

something goes wrong in thosehospitals without cardiologists’support, particularly when apatient has to be transported toanother hospital, and anambulance is stopped by trafficjams’.

Notwithstanding, the Ministerappears to be determined tocontinue with his plan. It isexpected that, by 2010, some40,000 Dutch patients will needballoon angioplasty due tonarrowing in the coronary artery.

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What if you couldaccess both an angiogram

and a chest x-ray in less time than it takes to read

this sentence?

ESMO LifetimeAchievement AwardThe Dutch Cancer Institute (NKI)has won the ESMO LifetimeAchievement Award, presentedby The European Society forMedical Oncology, for its‘excellent translational researchinto breast cancer’.

The NKI has bridged the fieldof molecular biological researchand the clinic. In particular it hasdeveloped genetic assays forbreast cancer that, according toESMO, lead to betterunderstanding of the disease andprobably to more precise and lessaggressive treatment.

The ESMO award – whichincludes €50,000 for research -was presented for the secondtime; last year it went to theBreast International Group (BIG),a platform for clinical researchinto breast cancer.

Apologies in stead ofcondolencesThe wife of a patient, who had been treat-ed in the intensive care unit of the MedischSpectrum Twente Hospital after receivingserious burns during a barbecue accident,received a questionnaire by post asking herto tell the hospital management about herexperience with condolences she hadreceived from the hospital. The hospitalletter arrived just as her husband arrivedhome. Its opening sentence read: ‘Recentlyyour husband died in the intensive careward….’ The hospital offered its apologies… better than condolences!

Surgery prohibitedThe Healthcare Inspectiongroup has ordered 14 hospi-tals to stop surgery on thegullet to remove a tumour. In2006, the hospitals had car-ried out this risky procedurealthough not able to achievethe norm of at least ten annu-ally, which the inspectiongroup found irresponsible.

Survival chances are 2.5times higher when this opera-tion is carried out in a hospi-tal experienced in this type ofsurgery, so the Inspectiondemands that hospitals per-form at least 10 a year.Research showed that half ofthe hospitals that wereallowed to operate did nothave the right intensive careunits for these patients. In all,600 patients have receivedgullet surgery.

Given the outstanding diversityof forums and workshops thisyear, what are the burning issues?‘The focus will be on ageing andchronic diseases, and healthy envi-ronments.’ Where do you expect consensussolutions? ‘The foundation of theGastein Group in the EuropeanParliament will serve as the basisfor a co-ordinated implementationof our recommendations.’The EHFG is a major tourismfactor for the Gastein valley. Dostatistics show its economic bene-fits here? ‘The Gastein valley has acentury-long tradition as a healthdestination, so the EHFG foundthe ideal venue. The Gasteiner


N E W S

EHFG celebrates10th anniversary

Recently retired, ProfessorGünther Leiner MD, founder andpresident of the EuropeanHealth Forum Gastein, wasformerly head of the Institute ofRheumatology, Rehabilitationand Holistic Medicine, in BadGastein. As a member of theAustrian Parliament he was alsoparticularly active in healthpolitics

Bad Hofgastein

In 1998, during Austria’s first EU presidency, ProfessorGünther Leiner founded the European Health ForumGastein (EHFG). From 3–6 October this year, the Forum willcelebrate its 10th anniversary. Our Austria correspondentHans-Christian Pruszinsky asked Dr Leiner about thevalue and role of this organisation in Europe today.

Looking back on the pastdecade, Dr Leiner is particu-larly happy that the EHFGhas established a network

and a forum where key stakehold-ers – from politics, industry, sci-ence and NGOs – meet to infor-mally exchange ideas. ‘Apart fromhigh level scientific discussion inthe workshops and forums, wehave created a communicationplatform for experts and decisionmakers in many different areas.This enables us to explore and dis-cuss major EU and WHO healthpolicy projects. Several of our sug-gestions have been debated in theEuropean Parliament’ (EP), hepointed out. Have his original goals beenreached? ‘My vision was to discussEuropean health policy issues on asupra-regional level and to inte-grate the four stakeholder groupsI’ve mentioned. To a large extent,this goal has been reached.However, we didn’t manage to theextent envisaged – the use of ourdiscussion results as the decisionbasis by national parliaments andby the EU Parliament – albeit thisis not quantifiable. Our resultswere presented to all parliamentsand relevant health policy commit-tees. It remains open as to how farthey contributed to the actualimplementation of health policies.’Of what is he particularly proud?‘The diversity of the participantshas developed significantly, notonly in terms of internationalisa-tion – see EU enlargement – butalso in terms of the interests of theparticipating decision makers.Health policy makers from allkinds of national healthcare sys-tems and with a wide variety offoci, representatives from large

medical technology and pharma-ceutical corporations, representa-tives of the social and healthinsurers, both private and public,numerous NGOs, patient lobbygroups, the media, decision mak-ers in clinical, care and adminis-trative functions, representativesof private and public hospitalsand other medical institutions –today, they all meet in Gastein.’ Is such a diversity of interests anddemands manageable? ‘Healthpolicy is still handled nationally. Ibelieve there are only a few impor-tant health policy issues that needdiscussion Europe-wide, whichmeans they are definable andmanageable.

‘Obviously, the interests of thestakeholders – nurses, patients,industry, politics and administra-tion – can differ widely. Also,groups such as the pharmaceuticaland medical technology industriesmight have opposing views. But inthe EHFG framework, time andagain we witness that the differentplayers forge issue-specific cross-sectoral coalitions. I guess mostlobby groups have understoodthat they can reach their goals byco-operating with others, becausesuccessful lobbying for specificand particular interests hasbecome extremely difficult. This istrue for many issues, for examplelong-term care for the chronicallyill, or patient safety, and issuesregarding healthcare as an eco-nomic and growth factor.’ Might the range of issues have tobe limited to enable their deeper

ry of key results and recommen-dations emerging from the event.Political activities do not beginwith the Declaration – they beginwith the informal meeting of thedecision makers in Gastein.There, we ‘sow the seed’. We haveoften seen the Declaration used asa discussion aid and guidance. I’mconvinced that many of our ideasmade their way to MEPs via ourpapers, providing scientific back-up for their policy initiatives.

‘I’d also like to stress that nei-ther event nor Declaration solelyaddress the EU level; they alsoclearly target national decisionmakers. From the beginning weintend feedback effects betweenthe national and the EU level, andbetween national levels. Due totheir diversity, European health-care systems are ideally suited toserve as incubators for new ideas.That’s one of the ideas behind theEuropean Health Forum Award,which we’ll present for the firsttime this year.’ What concrete successes has theForum achieved? ‘The creation ofa consultation mechanism regard-ing patient mobility is an exam-ple. Obviously, this suggestionwas included in the Declaration.Also, the European Commissionis about to adopt the first concretesuggestions to create a communityframework for healthcare ser-vices. If you look at this processand the Declarations you’ll realisethat the EHFG has promptedmany concrete impulses throughthe years.’

Kur (Gastein spa treatment) com-bines three local elements: thermalwater, steam bath and the ‘healinggalleries’. The combined use ofradon and warmth soothes painand contributes to post-traumarehabilitation. Our valley alsooffers a wide variety of sports –summer and winter.

‘During the three-day event heldin October, about 2,000 partici-pants stay here – in off-seasonGastein that’s significant. In addi-tion, over 60% of EHFG contractsare conducted with local compa-nies. The annual revenue generatedby the EHFG in the Gastein regionis around €500,000.

‘A further significant factor is thepromotional and advertising effectof the EHFG. Many participantsreturn for a vacation. Our eventelevates the image of the entire val-ley and strengthens the linkbetween tourism and health –which is so important for Gastein.

‘Between 1998 and 2006, wewelcomed 4,000 participants atEHFG, and the number is increas-ing.’On the EHFG’s 10th anniversary,as its spiritus rector and president,what’s your wish? ‘That health pol-icy issues that are discussed withearnestness and commitment byimportant personalities, and at avery sophisticated level, will beacknowledged, furthered andimplemented by politicians.

‘I’d like to also thank EuropeanHospital for many years of fruitfulco-operation, which I look forwardto continuing in the future.’

discussion? ‘We plan to offer sep-arate scientific symposia for thedifferent stakeholders, where top-ics that had been on the EHFGagenda and are particularly rele-vant for the individual groups canbe discussed in more detail. Weare also launching a ‘GasteinGroup’ of members for the healthcommittee of the EP and otherMEPs, to strengthen results of ourForum at a political level.’Since 2000, annual GasteinDeclarations have been presentedto the European Parliament. Havethey affected EU health policy?‘One should look at the Gasteinevent and the Declaration as aunit. The Declaration is a summa-

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News . . . . . . . . . . . .

. . . . . .1–6

Cardiology

supplement . . . . . . . . . . . .

7–17

Medica 2007

forecast . . . . . . . . . . . .

. . . . . 19

IT & telemed . . . . . . . . . 20–21

Respiratory

medicine . . . . . . . . . . . .

. 22–23

Wound care . . . . . . . . . . 24–25

Lab & pharma . . . . . . . . . . . 26

Surgery . . . . . . . . . . . .

. . . . . 27

Russian pages . . . . . . . . 28–31

contents

V O L 1 6 I S S U E 4 / 0 7

A U G U S T / S E P T E M B E R 2 0 0 7

7–17

Cardiology

● Nanoscale

contrast agents

● 1st AF monitoring

device implant

● Stem cells aid

cardiac repair

22–23

Respiratory med

● International

standards for TB care

● Portable device

measures StO2

● Monitoring asthma

and COPD1-6News

● Innovations in

radiology

● Game to aid

epidemiologists?

● Needle-free

device awarded

A pilot project begun in February

by the Ministry of Health and the

National Health Insurance Fund

(NHIF) has resulted in Bulgaria

issuing its first electronic medical

cards. The pilot project is run by

the international eHealth specialist

ICW* in partnership with the firms

Cisco and Kontrax.

From September 1,000 inhabitants

of the towns of Slivnitza and

Aldomirovzi (both about 30km

from Sofia) will receive personal

electronic medical cards (EMCs).

These will predominantly be given

to chronically ill patients by their

general practitioners (GPs) during

regular surgery visits. Patients par-

ticipating in this project were nomi-

nated by the GPs.

Each EHC is fitted with a micro-

processor chip that stores the

patient’s personal data, issue and

card number, and a security certifi-

cate; data that enables an automatic

check of the patient’s insurance sta-

tus and GP allocation.

Electronic receipts for drugs paid

for by the Bulgarian medical insur-

ance are also stored on the chip.

Currently the system is being test-

ed in a field project and participat-

ing doctors and chemists are receiv-

ing training from specialists at ICW

and Kontrax. After

these tests and training ses-

sions the pilot project will begin

and the first Bulgarian electronic

prescriptions will be issued.

In the first six months after the

official start of the project the infra-

structure was developed along with

specific software: All doctors and

chemists in Slivnitza and the NHIF

were linked to a reliable, secure

private network. Cisco supplied the

networking equipment, firewalls

and IP telephones.

ICW, main contractor and sys-

tems integrator for the project have

adapted their software solutions,

which have already been used in

Germany and Austria, to the spe-

cific requirements of the Bulgarian

healthcare system. The ICW soft-

ware development kit (SDK) seam-

lessly links the medical card system

with the software used in surgeries

and pharmacies. The Kontrax soft-

ware Hippocrates and the pharmacy

systems Pharmacy Expert supplied

by Libra Inc. and Pharma Star, sup-

plied by AS Systeme, can now com-

municate with one another through

the ICW eHealth- infrastructure

solutions.

The pilot project for the Bulga-

rian electronic medical card was

initiated by the Bulgarian Ministry

of Health and the NHIF. ICW was

appointed for its implementation in

co-operation with Cisco and

Kontrax.

* InterComponentWare AG (ICW) is

an international eHealth specialist

with sites in Germany, Austria,

Switzerland, the USA and Bulgaria

Diuretic pill extends life

UK & France – The Hypertension in the

Very Elderly Trial (HYVET), the biggest glob-

al clinical trial to assess the benefits of low-

ering blood pressure in patients aged 80+,

was halted in July, two years before its

scheduled completion in 2009. Christopher

J Bulpitt MD, the trial’s Principal

Investigator and Professor Emeritus of the

Care of the Elderly Department at Imperial

College London, said the interim findings

indicated that an inexpensive, low dose

diuretic (indapamide 1.5 mg sustained

release) and if needed, an additional ACE

inhibitor (perindopril), taken daily, reduced

the number of strokes and mortality at a

statistically significant level.

3,845 patients in seven countries

(Bulgaria, China, Finland, Romania, the

Russian Federation, Tunisia and the UK) par-

ticipated. The trial was designed to deter-

mine whether a 35% difference occurred

between a placebo and active treatment.

Secondary outcome measures included

total mortality, cardiovascular mortality, car-

diac mortality, stroke mortality and skeletal

fracture. All patients in the double-blind,

randomised, placebo-controlled trial, begun

in 2001, are being seen for a final visit.

Participants receiving a placebo will be

offered the option of switching to active

indapamide 1.5 mg SR-based antihyperten-

sive treatment.

Results from the HYVET trial, which was

funded by the British Heart Foundation and

the Institut de Recherches Internationale

Servier, in France, and co-ordinated by sci-

entists at Imperial College London, are

expected to be published in a peer-reviewed

journal and presented at a major medical

meeting in spring 2008.Report: Cynthia E Keen

Leaders launch a new

global health partnership

Richer countries urged

to fast-track Millennium

Development Goals

for healthcare UK & Germany – An Internat-

ional Health Partnership is to be

launched (5 September) to bring

together major donor countries,

as well as key international

agencies such as the World Bank

and the World Health

Organisation, to hasten the

Millennium Development Goals

(MDGs) that aim to reduce

infant and maternal mortality

and tackle HIV/AIDS, polio,

measles and many other diseases.

The new partnership follows

talks at 10 Downing Street

between the UK’s new Prime

Minister Gordon Brown and

German Chancellor Angela

Merkel, who later jointly

announced that addressing

healthcare and aid provision was

now a ‘development emergency’.

Speaking at the United Nations

in June, Prime Minister Brown

had urged the most developed

countries to get back on track

with meeting their jointly agreed

Millennium Development Goals

(MDGs), which were established

by the UN back in September

2000. These include specific

commitments, such as eradicating

extreme poverty and achieving

universal primary education – aims

to be met by 2015.

For her part, earlier this year

Chancellor Merkel had led the G8

summit, when the world’s richest

nations promised to honour

financial commitments and

improve the co-ordination of aid

with national health plans of

recipient countries.

The two leaders pointed out that

the MDGs that focus on healthcare

were the ‘least likely to be met’ by

the agreed target date of 2015,

adding that an ‘improved

approach’ was needed. This would

entail strengthening of ‘weak

systems’ that suffer a lack of

workers and clinics, and improving

co-ordination of ‘complex’ and

‘fragmented health provision’.

Following their meeting, Prime

Minister Brown said: ‘We re-affirm

our commitment made at the G8

and the EU to provide the

financing needed to meet our

health commitments through the

established institutions and

mechanisms. In this context, the

replenishment of the Global Fund

will be a key step. We will also

explore innovative financing

mechanisms to meet these

commitments.’

They two leaders stated: ‘We see

this [the new partnership] as a

critical step in our call for an

international mobilisation of effort

to achieve the MDGs that will

build year on year until 2015. Our

efforts must bring together the

private sector, NGOs, faith

groups, international agencies and

governments in a new partnership

to reduce poverty, improve health

and provide opportunities for the

poor across the world.’

During a press briefing,

Chancellor Merkel added: ‘We

strongly welcome the British

initiative, which is aiming at us,

combined with the Millennium

Development Goals, and that is

the health initiative that the British

have proposed. We believe that it

indeed offers us an opportunity to

help us efficiently work towards

our compliance with those

Millennium Development Goals. I

will be travelling to Africa very

soon and I will do my best to

canvas for their support.’

Bulgaria issues first electronic medical cards

Productivity

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Russian summaries:

Read pages 28–31!

Обзор статей на

русском языке

читайте на стр. 24 –27!

T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K

State-of-the-art

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N E W SEVENTS4-8 JUNE

2008CANADA

The 5thWorldConference onBreast Cancer‘Come and experience the greatCanadian Prairie Hospitality!’ say theorganisers of the 5th WorldConference on Breast Cancer(WCBC), to be held in June next yearin Winnipeg, Manitoba – the ‘culturalcradle of the nation, gateway to theCanadian west, and a meeting placefor over 6,000 years,’ the WCBCFoundation points out.

Attracting international speakersand offering interactive workshops,as well as poster exhibits, the eventwill not only be attended by medicalexperts, but also patients, as itintends to further highlight breastcancer in men and women andenrich international knowledgeexchange.Details: www.wcbcf.ca E-mail: [email protected]

Moscow’s‘Medical Fair’From 19-22 September this year, the‘Moscow Medical Fair’ will be heldfor the third time.

During the four-day event, in theManezh Central Exhibition Hall,representatives of medical centres,sanatoriums and spas, based inRussia as well as other countries, willpresent potential patients/clientswith their diagnostic methods andtherapies, or preventive medicine andrejuvenation (beauty) treatments.Details: www.global-expo.ruwww.mosmedsalon.ru

One forthe diary!The World ofHealth IT Austria - Following the first World ofHealth IT Conference & Exhibitionlast year, the organisers have decidedthat the 2007 meeting (22-25October) will ‘move on fromexploring fact-based IT solutions toexamining health IT in the widercontext of health delivery’.The line-up of ‘star’ speakersincludes:Richard Granger, who recentlyresigned his post as Director Generalof IT for the UK’s National HealthService, in which he has served forfive years. He is recognised for his‘outstanding contribution’ to amassive modernisation programmethat has made the NHS one of theworld’s largest networked and HL7-compliant infrastructures.Robert M Kolodner MD, NationalCoordinator for Health InformationTechnology at the Department ofHealth & Human Services inWashington DC, USA, a post towhich he was appointed in April thisyear to advance the US President’sHealth IT Initiative.Richard C Alvarez, President & CEOof Canada Health Infoway, who isrecognised for his contributiontowards developing a national visionfor reforming Canada’s healthcaresystem by using innovation andtechnology.

An event not to be missed byhospital and healthcarecommunications specialists.Details: www.worldofhealthit.org

No predicted boom in medical tourism ‘The world at home in German hospitals’– thousands of wealthy foreign patientscoming to boost budgets, this was thehope of many hospitals. Then along camea sobering study from Sozial undSeniorenwirtschaftszentrums GmbH (SWZ),conducted within the framework ofHealthcare Export Projects, which arefunded by the German Ministry forEducation and Research to design, estab-lish and market international healthcarenetworks.

In 2004, the study reports, only 50,000foreign patients became in-patients inGermany, and most of them went toNorth Rhine Westphalia and Bavaria.

However, 80% of these patients did notchoose to check-in. Unhappily, they wereemergency cases. Only 11,000 foreignershad travelled to the country for a specifictherapy.

The figures indicate that luxuriousrooms,VIP service and tourist sights alonedo not attract foreign clients – anassumption corroborated by this figure:only 675 financially most promising‘deluxe’ patients from the Arab Emiratesfound their way to German hospitals.

Among those who did opt for aGerman hospital ‘proximity’ played amajor role. Thus North Rhine Westphaliabenefited from Dutch and Belgian

patients, Bavarian hospitals recordedpredominantly Italian and Austrianpatients. Moreover, socio-cultural con-siderations came into play as the ratherhigh number of Turkish patients (2 000)indicate: because in some regions, e.g.North Rhine Westphalia, a large per-centage of hospital staff is Turkish, lan-guage and cultural barriers are removedand the patients feel well treated.

A third criterion that influences thechoice of hospital is the internationalreputation of the lead physician, whichin most cases means that the he or sheis specialised in treating certain condi-tions, or in using certain procedures.

‘Top medicine’ no doubt attracts foreignpatients.

If congenital heart diseases requiretreatment, foreign patients entrust them-selves to medical expertise found inBerlin; Hamburg is renowned for totalendoprosthesis, and North Rhine West-phalia focuses on treatments for epilepsyand chronic cardiovascular diseases.

This indication-based specialisationmight in fact offer a solution to fill theempty ‘deluxe’ beds in German hospitals,and in the end turn the ‘guest patient’concept in to a success story. The SWZpresented its study and discussed futurestrategies at the Hauptstadtkongress inBerlin this June.

Details: www.swz-net.de

Taking DigitalRadiographyto the NextLevel

Carestream Health is the trade mark of Carestream Health Inc.Kodak and DirectView are trade marks of Eastman Kodak Company.©Carestream Health Inc., 2007

We’ve broken away from tradition with a design thatincorporates both the tube and detector in the ceiling-mounted 3D U-arm. Now, the system moves easilyaround the patient to capture images on the left and rightside of the body without the need for additional patientpositioning. That means enhanced workflow for you andgreater comfort for your patients—a winning combination.

Introducing the radically different KODAK DIRECTVIEW DR 9500 System

Advantages of the new design include:

• Two operator interfaces on the 3D U-arm allow you tochange the X-ray generator parameters and settings withoutleaving your patient

• With auto-positioning the system moves into the pre-programmed position for the next exam

• The bucky and tube are always aligned giving you confidencefor faster positioning.

www.carestreamhealth.com

Needle-free drug deliverydevice scoops top award


N E W S

EPIDEMIOLOGYN E W SN E W S - I N N O V A T I O N S

Could a virtual gamehelp pandemic studies?

Figure 2: Hakkar, the primary source of infection in World of Warcraft

USA – Online game worlds might proveuseful for the study of a spread of humaninfectious diseases, according to scientistsEric Lofgren and Nina Fefferman, ofRutgers University (Piscataway, NJ, USA)and Tufts University (Boston, MA, USA).In the September issue of The LancetInfectious Diseases they describe how aprogramming error in a popular onlinerole-playing game, World of Warcraft,caused a full-blown epidemic of a virulent,highly contagious disease. Althoughcomputer models of infectious diseases areof increasing importance, a limitation ofthese models is that they cannot predictthe behaviour of individuals. The scientistsrealised that appropriate exploitation ofonline games might alleviate thisconstraint, since players’ economic andsocial behaviour often mimics their real-world behaviour.

The outbreak began when BlizzardEntertainment released an update inSeptember 2005, allowing higher levelplayers to access a new area of the game.Players experienced combat with apowerful creature called Hakkar, whooccasionally infected players with‘Corrupted Blood’. To the powerfulplayers Corrupted Blood was no more ofa hindrance than a cold, but a game-wideepidemic started after many characters

RADIOLOGY

Symposium: Innovationsin medical imaging

The Forum’sManagingDirector, DrThomas Feigl,greeted around150 participants

teleported – a common feature of the game– back to urban areas before being killed orcured of the disease, where they infectedmore susceptible players.

The Forum Medizintechnik-Pharma – anassociation that provides a recognisedcontribution to the development of theco-operative environment in medicine,technology and pharmaceuticals, metfor a symposium in Germany this July.Attended by representatives from mem-ber institutions, which number 560 from14 countries (in Europe as well as theUSA and Far East) it was chaired byProfessor J. Ruediger Siewert MD, alsochairman of the board of HeidelbergUniversity Hospital, focused on medicalimaging. This includes X-ray technology,encompassing all conventional tech-nologies and computed tomography(CT), magnetic resonance imaging (MRI)and ultrasound (US).

Innovations in X-ray technology focuson digital post-processing of image dataand on automation and standardisationof examination workflow. Currently,PET-CT is experiencing a boom. Thestand-alone PET (Positron EmissionTomography) has been fully replaced bythe combination of PET and CT. In onescan PET-CTs provide images whichallow precise interpretation, in terms ofmorphology as well as metabolism (NB:In our next EH issue we will publish aninterview with Dr Thomas Beyer ofPhilips Medical Systems on this subject).

In recent decades MRI has developedinto an eminently successful imagingmodality. MRI advantages include non-invasiveness and non-ionisation, and itcan be used in a wide range of applica-tions. However, like any other physical

procedure, MRI has limitations. As far asclinical applications are concerned, theselimitations can best be described by theso-called ‘magic triangle’: the interdepen-dence of signal-to-noise ratio (SNR), scantime and image resolution. The develop-ment of coil arrays for signal detectionallowed parallel data capture and thussignificantly accelerated the imagingprocess. Current research is looking atfurther scan acceleration and whetherand how it can be reached with multi-channel coil arrays.

In ultrasound technology new develop-ments and the two-dimensional Dopplertechnique provide unmatched spatial res-olution. Optimisation of signal receptionturned out to be insufficient to realisespatial resolution of less than 5 mm. Inprevious ultrasound technology thewaveform of the pulse depended primar-ily on the transducer’s crystal propertiesand its backlash.

In modern compound wave generators,however, an electrical pulse which isadapted to the crystal properties avoidsbacklash and thus generates short micropulses with clearer echo signals whichsignificantly improve resolution.

All technological developments are dri-ven by the need to provide the clinicaluser with high-quality, efficient andpatient-friendly diagnostic imaging toolsand methods. The symposium offeredinteresting insights in the state-of-the-arttechnology but also allowed a glimpse atthe next generation of medical technolo-gy equipment. Report: Guido Gebhardt

Blizzard Entertainment’s quarantinestrategy failed because of the highlycontagious nature of the disease, theinability to seal off a section of the game

world effectively, and player resistance tothe notion. Fortunately, the gamedevelopers had one additional option notavailable to public-health officials:resetting the computers.

This is the first time a virtual virus hasinfected a virtual human being in amanner even remotely resembling anactual epidemiological event. Currently,epidemiologists face major constraints instudies of diseases dynamics because theyare limited to observational andretrospective studies. Computer modelsallow for experimentation on virtualpopulations without such limitations, butthey rely on mathematical rules toapproximate human behaviour. Bycontrast, human-agent virtual simulationmay bridge the gap between real worldepidemiological studies and large-scalecomputer studies by including thevariability and unexpected outcomes thatarise as a result of the behaviour ofindividuals. Lofgren and Fefferman say:‘We believe that, if the epidemic isdesigned and presented so as to seamlesslyintegrate with the rest of the persistentgame world, in such a way as to be partof the user’s expected experience in thegame, a reasonable analogue to real-worldhuman reactions to disease might beobserved and captured within a computermodel...By using these games as anuntapped experimental framework, wemay be able to gain deeper insight into theincredible complexity of infectious diseaseepidemiology in social groups.’Source: The LancetDetails: Nina Fefferman.Phone: +1 781 710-5025 Email: [email protected]

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The Glide Solid Dose Injector (SDI), theneedle-free drug delivery system thatinjects drugs in solid dosage form intothe skin, has contributed to its manu-facturer, Glide Pharma, winning theBest Business Award at the 2007Medical Futures Innovation Awards.The competition had attracted over500 entries. The Best Business Award isgiven to the overall winner fromamong the 25 award winners. GlidePharma located at Milton Park,Oxfordshire, also won the BestBusiness Proposition Award in theAnaesthesia & Critical Care category,sponsored by Abbott Laboratories.

Ease of use also makes it ideal forself-administration e.g. by diabetics,and the device also eliminates needle-stick injury and disposal problems.

Glide Pharma is developing a rangeof new drug products for use with thesystem, the first of these to commence

clinical trials shortly. This contains thedrug octreotide acetate, a top sellerfrom Novartis that recently came ‘offpatent’. It is used to treat neuro-endocrine tumours prior to surgery, aswell as acromegaly, a chronic conditioncaused by abnormally high amounts ofgrowth hormone.

Dr Charles Potter, Founder and CEOof Glide Pharma, received the BestBusiness Award at a glittering ceremo-ny in London. He said the award hadcome at a time when the company ismaking excellent progress in produc-tion and partnerships, and is advancingthe first of its own brand products, andnegotiating with many major pharma-ceutical partners to co-develop theGlide Solid Dose Injector with their pro-prietary drugs and vaccines.

The Medical Futures Awards judgingpanel included leading healthcareexperts such as Sir Magdi Yacoub, pio-

Dr Charles Potter, Founder & CEO of Glide Pharma, receives the Best Business Award 2007from actress Joanna Lumley at the Medical Futures Innovation Awards Ceremony.Left to right: Joanna Lumley OBE; Chris Gorman OBE; Dr Charles Potter (Founder & CEO,Glide Pharma) and Roberto Solari (CEO, MRC Technology)

neer of the heart and lung transplant;Baroness Susan Greenfield, Professorof Pharmacology at the University ofOxford; and Sir Richard Sykes, formerChairman and CEO ofGlaxoSmithKline and currently Rectorof Imperial College. Complementedby business experts, such as Sir VictorBlank, Chairman of Lloyds TSB GroupPlc; and Sir Michael Sherwood, ChiefExecutive of Goldman Sachs, thepanel is Europe’s leading think tankon health and business innovation.

Andy Goldberg, founder of MedicalFutures, said: ‘Nine out of 10 of thelargest medical technology compa-nies are US-based, yet the UK pro-duces some of the world’s best ideas.Medical Futures has demonstrated astrong pipeline of innovations set tobecome the next high growth areaand prove that the UK can be a worldbeater.’


It’s ESC time again!And the focus is heart failureGiven the exponential increase in the patientspresenting with heart failure in recent years, a totalof 53 sessions have been dedicated to the topic ofheart failure. The sessions include clinical updatesand state-of-the-art lectures, but also the newest ondiagnosis and therapy will be presented. In theirwelcoming address, Kim Fox and Jeroen Baxhighlight some of the lures of this important andnotable event for cardiologists worldwide

1–5 September and the Viennavenue for the annual Congress ofthe European Society ofCardiology (ESC) will engrossabout 22,000 people, arrivingfrom all over the world to attendEurope’s biggest cardiologymeeting. 351 sessions areplanned to take place in 28rooms, and there will be manypresentations of originalscientific work.

Four named lectures – fourpresenters● The William Harvey Lecture

on Basic Science will bepresented by Professor PCarmeliet

● The Geoffrey Rose Lecture onPopulation Science byProfessor P Puska

● The Rene Laennec Lecture onClinical Cardiology byProfessor W McKenna

● The Andreas GruentzigLecture on InterventionalCardiology by Professor TLuescher.

The Focus sessionsThese consist of livetransmissions from Europeanlocations – Katowice, Berlin, BadNauheim, Bern and Vienna – todemonstrate practical skills inimaging and intervention.Clinical Practice sessions willencourage interactive discussionsbetween an expert panel andaudience. Two of the session willfocus on mild heart failure (HF)and end-stage HF.

Joint sessionsThe American Heart Associationand the American College ofCardiology, as well as societiesrepresenting subspecialties suchas hypertension, atherosclerosisand diabetes, etc. will presentjoint sessions.

12 main sessionsThese will be packed withimportant clinical topics, e.g. therelation between anaemia andheart failure, or the role of BNPin heart failure.

The safety of drug-elutingstents will be another hotlydiscussed subject, as will theincreasing role of non-invasiveimaging using differentmodalities, and the developmentof percutaneous valve therapy.

New ESC guidelinesFive new ESC guidelines are tobe released on acute coronarysyndromes without ST elevation,valve disease, cardiac pacing,hypertension and prevention ofcardiovascular disease. In

addition, the new UniversalDefinition of MyocardialInfarction (endorsed by the AHA,ACC and ESC) will be presented.

The EHSPLessons from the Euro HeartSurvey Programme – an extensivequestionnaire involving manyhospitals in ESC countries acrossEurope – will be the focus of fourother sessions.

Annual meetingsThe five ESC Associations willreport on their annual meetings orpresent their news in 90-minutesessions organised in theAssociation Corner. The fiveinclude subspecialisations –echocardiography, heart rhythm,prevention, percutaneous coronaryintervention, and heart failure.

Working lunch Participants can also fill theirlunch periods with attendance atnine practical sessions under thebanners Meet the Expert; Readwith the Expert, and How to.

Three Hotlines - Two ClinicalTrial Updates Late-breaking trials and the mostrecent updates on published trialswill be presented. These sessionsfrequently include large, random-ised clinical trials that have majorimpact on patient management.

Basic ScienceThe Council for BasicCardiovascular Science will presentsessions in a bench-to-bedsideformat, focusing on thetranslational aspect of basicscience, but also highly specificbasic science research will bepresented.

Abstracts and postersSubmitted abstracts: almost10,000. Reviewers to gradeabstracts: Acceptance rate: 37%.

New for 2007: the State-of-the-Art and Featured Research Track.Sessions will include a keynotelecture by an expert, combinedwith four oral presentations of thehighest ranked abstracts on aspecific top.

Kim Fox, President of theEuropean Society ofCardiology

Jeroen Bax, Chairman ofthe Congress ProgrammeCommittee

Professor Hamm: ‘As far as the visualisation of vessels and vessel periphery isconcerned, MRI has made other imaging modalities all but obsolete. Whole-bodyangiography, which is state-of-the-art MRI technology, for the first time offers thepossibility to visualise all vessels non-invasively. Patients who suffer from a stenosis– which in most cases is accompanied by arteriosclerosis – will particularly benefitfrom this new technology. Arteriosclerosis is a systemic condition, which quite oftenmeans you will find stenoses in different regions of the body that have not yetbecome clinically relevant. In such cases, whole-body angiography can significantlyinfluence therapy management: Imagine a patient who is diagnosed with a stenosisin the pelvic region but the whole-body angio shows a second stenosis, for examplein the carotid artery. Obviously, to prevent future intra-operative complications, wewill treat the latter first. This non-invasive method has many advantages – both forthe physician and patient.’What role does molecular imaging currently play in cardiology?‘In molecular imaging we – just like everyone else – are in the very early stages. Wedo basic research, so to speak. Research into the visualisation and differentiation ofstable and vulnerable plaque is very important for us. Vulnerable - that is inflamed -plaque can rupture at any moment and cause thromboses, which are often fatal. Atthis point we do not have a method do distinguish vulnerable from stable plaque.This is where molecular medicine comes in: The macrophages (cells that play acrucial role in the inflammation process of the plaque) bind well with magneticnano particles. In the Nano for Life Working Group, a research co-operation betweenSiemens and here at the Charité in Berlin, we work with ultra small iron particlesthat can make vulnerable plaque visible in MRI. Even more: we can determine thestatus of the inflammation, because the higher the inflammation activity the betterthe uptake of the iron markers. Based on the number and distribution of the markersin the body, we can then provide a very precise risk analysis for the patient. MRI isthe most sensitive procedure to visualise these markers.

‘There are also CT research projects that are important for cardiology – the non-invasive visualisation of the coronary vessels, for example. We are working with a64-slice CT which is able to visualise the coronary vessels very reliably.

‘In summary we expect immense progress in cardiological imaging in the nearfuture – progress which will enable us to diagnose diseases earlier and moreprecisely.’

MRI and the diagnosisof arteriosclerosis andplaque imaging

EUROPEAN HOSPITALThis special cardiology supplement is a EUROPEAN HOSPITAL publication

www.european-hospital.comCARDIOLOGY

The spatial-anatomic visualisation offered by MRIalready provides immense diagnostic possibilities forcardiology. However, as yet, the potential of thisimaging modality is far from exploited, according toProfessor Bernd Hamm (right), of the RadiologyDepartment at the Charité Hospital, Berlin. DanielaZimmermann of European Hospital, asked him why

SEPTEMBER 2007

ALL HEART SURGEONS CUT WITH YELLOW

BOWA-electronic GmbH & Co. KG I Heinrich-Hertz-Strasse 4 –10

72810 Gomaringen I Germany I [email protected] I bowa.de


C A R D I O L O G Y

Hot Spots:NANOSCALE CONTRASTAGENT FOR IMAGINGCORONARY ARTERIES

VSOP particle with yellow molecules indicating the citrate bound to the iron oxide surface (grey).Functionalisation of the particle by specific peptides e.g. Annexin V

‘The tiny particles under investi-gation are less than sevennanometres across, with an ironcore that is highly responsive to the intense magnetism of anMR system. Most MR imaging of coronary arteries alreadyemploys contrast agents toimprove image quality. Coronaryarteries are small and due to themovement of the heart duringthe cardiac cycle, there is very lit-tle net imaging time, so you needa contrast agent to get a suffi-cient signal-to-noise ratio. Thesuper paramagnetic iron oxideparticles under developmenthave an optimal signal-enhancingeffect far above that of existingcontrast agents. An ongoingphase II trial is measuring bloodflow through coronary arteries.The goal is to compare imagesmade with the nanocontrastagent to those made with tradi-tional X-ray angiography.

A second application for thehighly responsive nanoscale par-ticles is more speculative, butcould prove more valuable. Withassistance from Siemens, the con-sortium leader of Nano AG, Prof.Taupitz and colleagues at otherluminary academic sites are try-

ing to attach the tiny particles topeptides that bind to specificstructures in the body, whichcould turn the nanoparticles intodisease–hunters inside the body.

To detect arterial plaque, thenanoscale iron oxide particlescould be attached to a factorthat would, in turn, attach tocompounds involved in apopto-sis. Programmed cell death in theartery wall is one sign of vulner-able plaque. A second tacticcould link to compounds associ-ated with angiogenesis, whichoften occurs in unstable plaque.In either case, the tiny particleswill enrich within the pathologicvessel walls and generate hotspots on a MR image.

Currently, physicians must relyon indirect methods to specifi-cally image diseased arteries. Itis a change in paradigm for vas-cular diagnosis. We may have tolook not so much at flow-limit-ing stenosis, or narrowing, but atthe composition of the plaquesand the change in the vesselwalls. Using a specific contrastmedium means to get functionalinformation and then to make aprediction of the risk of plaquerupture in the artery.‘

A next-generation diagnostic tool for cardiovasculardisease, using a nanoscale iron particle, is now underdevelopment at a unique industry-government-university named Nano AG. A report from Siemensdescribes the research and progress at the centre

A new blood pressure (BP) mea-suring device that provides,along with all the conventionalcardiovascular parameters, thecardiac stroke volume, peripher-al resistance and arterial aug-mentation, has been developedat the Austrian Research Centre(ARC), Vienna-Seibersdorf. Theresult of seven years’ work byresearchers, the device, namedCardioMon, is now ready forsale.

The ARC refers to one study inparticular to underline the needfor their advanced measuringsystem. Conducted during aVienna Cardiovascular Eventsprogramme in 2005, within oneweek the blood pressure of7,018 patients was measured. Of

BP measuring deviceNEW

those, 1,109 people were receiv-ing treatments. However, only175 were being correctly regulat-ed, mainly because conventionalblood pressure measuring meth-ods could only indicate symp-toms, but not the cause of prob-lems. For those, invasive meth-ods, such as catheterisation, havebeen necessary. The ARC reportsthat its CardioMon will makesuch a difference to this, that itwill have supplanted all conven-tional blood pressure measuringtools in just a few years.

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For and againstBy Dirk Boese MD, with S SackMD and R Erbel MD, of the WestGerman Heart Centre in Essen,and Cardiology Department atthe University of Duisburg-Essen,GermanyCoronary stents provide wall wrappingof dissection, prevent elastic recoil,and reduce restenosis afterpercutaneous transluminal coronaryangioplasty. In addition, drug elutingstents loaded with antiproliferativeagents inhibit intimal hyperplasia andoffer a further reduction of restenosis.But stents are foreign bodies (‘metaljackets’) that transform elastic vesselsinto rigid tubes, impair vasomotion,and, due to the potential risk of evenlate thrombosis, require long termantiplatelet treatment.

To overcome limitations of currentstent technology, a magnesium-basedabsorbable metal stent (AMS-stent)was developed in Berlin, by BiotronikGmbH & Co, and successfully tested inanimals and below the kneeinterventions. The magnesium stentprovides vessel scaffolding within thefirst weeks after implantation and iscompletely absorbed within eightweeks before long term complicationsmay occur.

The efficiency of absorbable metalstents in the treatment of coronary

Final angiographic result after implantation of a 3.0x15 mm AMS-stent in a proximal rightcoronary artery. Arrow indicates stented segment. Intravascular ultrasound examinationindicated a good stent expansion with complete stent apposition (Panel A). After four months,angiography revealed a good long term result, without significant restenosis. IVUS- controlproved a nearly complete absorption of the AMS-stent with only stent remnants (Panel B).

Absorbable metal stents

Absorbable metal stent (from Biotronik) after expansion (left panel) and in electron microscopymagnification (right panel)

stents (elastic recoil ~ 7%) and noMACE (Major Adverse Cardiac Events)were observed during hospital stay.After four months, the ischemic drivenrevascularisation rate was 23.8% andtherefore comparable to conventionalstainless steal stents. Intravascularultrasound (IVUS) examination duringfour months follow-up demonstratedan advanced absorption process withonly small ‘stent remnants’. In the 12month clinical follow-up period nostent thrombosis was observed.

This study is the proof of conceptthat biodegradable magnesium stents

artery stenosis was determined in thePROGRESS-AMS (Clinical Performanceand Angiographic Results of CoronaryStenting with Absorbable MetalStents) clinical trial. Seventy-onestents (3.0 - 3.5mm in diameter) weresuccessfully implanted in severecoronary stenosis of 63 patients(mean age 61.3 ± 9.5 years).Procedural success could be achievedin all patients and the diameterstenosis could be reduced from 61.5%(±13.1%) to 12.6% (± 5.6%). Duringimplantation, the stent characteristicswere comparable to stainless steal

Dr Dirk Boese, West German Heart Centre, Essen

can achieve an immediate resultsimilar to the result of other metalstents and be safely degraded afterfour months. Nevertheless, therestenosis rate remains high andmodifications of the stentcharacteristics, i.e. prolongeddegradation and/or drug elution areobjects of further developmentaddressing the problems of excessive

recoil and proliferation.Due to reduced radiolucency of the

used magnesium alloy, the AMS-stentcannot be visualized by X-ray andinduces no metallic artifacts duringassessment with computedtomography and magnetic resonance.This characteristic allows the non-invasive assessment, even of thestented segment, after implantation ofan AMS-stent and gives newopportunities in the follow-upexaminations after coronary arteryinterventions.Contact for references and furtherdetails: Dr Boese. +49-201-7234888e-mail: [email protected]


C A R D I O L O G Y

Cardiac resynchronisation therapy Worldwide clinical trial gets underway Switzerland – A clinical trial ofcardiac resynchronisation therapy(CRT) in patients with advancedheart failure and a narrow QRScomplex <120 ms, has been initiat-ed by Zurich University.

The clinical benefits of CRT, asan adjunct to drug therapies, inpatients with NYHA class III/IVheart failure (HF) have beenshown repeatedly in randomisedtrials and clinical practice. TheMiracle ICD trials [Young JB,Abraham WT, Smith AL, et al,.Combined cardiac resynchronisa-tion and implantable cardioversiondefibrillation in advanced chronicheart failure: The MIRACLE ICDTrial. JAMA. 2003;289:2685-2694], and Companion trials [Bris-tow MR, Saxon LA, Boehmer J etal. Cardiac-resynchronisation ther-apy with or without animplantable defibrillator inadvanced chronic heart failure. NEngl J Med 2004;350:2140-50]suggested that CRT, which pacesthe left as well as right ventriclessimultaneously, used in conjunc-tion with an implantable car-dioverter defibrillator (ICD)improved the quality of life, func-tional capacity and exercise testperformance in patients with HFwith a wide QRS (�120 ms) inter-val. Indeed current guidelines forthe selection of suitable patientsfor CRT based on the publishedevidence advise that optimal candi-dates to benefit from CRT haveQRS >120 ms. [Strickberger SA,Conti J, Daoud EG et al. Patientselection for cardiac resynchro-nization therapy: from the Councilon Clinical Cardiology Subcom-mittee on Electrocardiography andArrhythmias and the Quality ofCare and Outcomes ResearchInterdisciplinary Working Group,in collaboration with the HeartRhythm Society. Circulation2005;111:2146-50.]

This means that until now, themajority of HF patients, thosewith a narrow QRS complex, havebeen excluded from CRT, althoughsuffering from dyssynchrony. TheEchocardiography guided CardiacResynchronisation Therapy(EchoCRT) study aims to providethe necessary evidence base toexpand therapeutic options for thispopulation.

EchoCRT is the first prospective,randomised clinical trial to evalu-ate the impact of cardiac resyn-chronisation therapy in HFpatients (NYHA Class III) whoshow mechanical dyssynchrony asassessed directly by echocardiogra-phy. Echocardiogram (ultrasoundof the heart) will provide a directmeasure of ventricular dyssyn-chrony, which is not apparent onindirect assessment by ECGbecause of the narrow QRS. Morethan 1,000 patients with advancedHF (NYHA Class III) will be ran-domised into treatment groupswith CRT or no CRT. Both groupswill receive an ICD to protectagainst sudden cardiac death, butin only half of the patients will theCRT capacity be switched on.

The co-principal investigators inZurich are Dr Frank Ruschitzkaand Dr Johannes Holzmeister.

In an interview with DrRuschitzka, we asked why Zurichhas become the international cen-tre for this study and what therationale is behind the EchoCRTtrial.

‘This is a very large clinical trial

of a medical device and willinvolve 120 different centresworldwide, but it’s led by Zurichbecause of our wealth of experi-ence in clinical cardiology trials.’The trial is sponsored by Biotron-ik, which manufactures theimplanted devices but, DrRuschitzka pointed out,‘EchoCRT is an independent,investigator led trial overseen by

an international executive com-mittee.’

‘Many cardiologists feel, as Ido, that we are not treating manyHF patients who would benefitfrom CRT simply because thereare no scientifically evidence-based guidelines telling us to. Ihave used CRT successfully inpatients with narrow QSR, and sohave many others. The medicalliterature supporting this belief isincreasing with observational

studies and anecdotal cases of suc-cess in several thousands of thesepatients.

‘The ESC recently conducted apoll asking its members if theythought patients with a narrowQSR would benefit from CRT.The time is now right for a large-scale, international trial to providethe definitive answer. Recruitingwill begin in the first quarter of2008 and will probably last for upto two years. The trial itself will

probably run for a further two orthree years after recruiting is com-plete depending on when we reachthe numbers required statisticallyof primary end-point. It would bestopped immediately if it becameobvious that the benefits of CRTtherapy were statistically superior.The results are due in 2011.

‘I’m very confident that CRT isthe way to go with HF patientswith narrow QRS. These are verysick patients with a high morbidityand mortality. I am convinced thatit is unwise to withhold CRT fromthis population and that EchoCRTwill provide the necessary evidenceto support this treatment change.’

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Progenitor cell transferfor cardiac repair after myocardial infarction

By Stefan P Janssens,Professor ofMedicine at theCardiologyDepartment,GasthuisbergUniversity Hospital,KU-Leuven, Belgium

Progenitor cell transfer torepair the damaged hearthas emerged as aninnovative and promising

recent development incardiovascular medicine. Since thefirst reports that adult bonemarrow-derived stem cells werecapable of transdifferentiatinginto a cardiomyocyte phenotype,research in regenerative medicinehas advanced in an explosivemanner.

A variety of progenitor celltypes that reside in bone marrow,

The therapeuticpotential of adultstem cells in CVDsBy Professor Bodo-Eckehard Strauer MD, Head of the Department ofCardiology, Pneumology and Angiology at Dusseldorf University Hospital

Fig. 2: Test results from 50 patients with acute myocardial infarction –controlled studies. Before cell therapy i.e. on the 8–9th day after infarction, andthree months after cell therapy

cell transfer of variable magnitude(absolute increase ranging from1.2 to 2.5%). The latter wasassociated with a favourableeffect on myocardial perfusion(evaluated as coronary flowreserve), infarct remodelling witha greater reduction in infarct sizeand greater recovery of regionalLV function. Although we are stillin a preliminary phase of clinicaldevelopment, meta-analysis ofpublished randomised controlledtrials and cohort studies of bonemarrow cell transfer (including

Cardiac infarction ischaracterised by tissueischaemia with loss ofcontractile heart muscle. Theconsequence is cardiacinsufficiency and disturbanceto cardiac rhythm. About twothirds of all patients have nosymptoms before aninfarction; about two thirds ofall patients do not survivetheir cardiac infarction. Abouta third of surviving infarctionpatients experienceincreasingly worsening heartfunction in the first year afterthe infarction (remodelling).

The aim of therapy is to re-open the infarcted vessel usingacute procedures (balloondilatation and stentimplantation), though this ismerely the tip of the icebergand the destroyed heartmuscle usually remainsuseless. This is wheretreatment with stem cellscomes in as causal therapy,striving to regenerate heartmuscle by injecting stem cellsinto it.

Fig. 1: Method for intracoronary stem cell transplantation: Site of the primary vascularocclusion caused by infarction is dilated with a balloon catheter and bone marrow stem cellsare simultaneously and repeatedly injected into the ischaemic area or infarct. This isundertaken in the acute infarction stage (2–8 days after infarction) and in the chronic stage(up to 8 years subsequently). Injection total: 100 to 200 million bone marrow stem cells. Fourto six pressure insufflations. Length of PTCA time: approx. 3–4 minutes

Fig. 3: Ejection fraction over a period up to three years after stem cell transplantation.Maintained improvement can be seen in patients who received stem cell treatment (TX)

Fig. 4: Stem cell transplantation procedure inperipheral occlusive disease. Combined intra-arterial and intramuscular injection. For bettermigration, stem cells are injected after repeatedcompression using a cuff and ergometry loading

or circulate in the blood, arecapable of improving function ofthe infarcted heart in pre-clinicalmodels, but underlyingmechanisms remain incompletelyunderstood. Consequently, thetraditional view of the heart as aterminally differentiated organ hasbeen challenged by several groups,who have reported the isolation ofcardiac stem or progenitor cells -characterised by the absence oftraditional cardiomyocyte,endothelial, or smooth musclemarkers, and that have a slowturn-over rate, and mightconstitute an endogenous reservoirfor cell-based repair.

However, massive cell loss ofcardiomyocytes and theseprogenitors alike, such as afteracute myocardial infarction,precludes sufficient repair capacityof these endogenous progenitorsin the infarcted territory. Therefore,cell-based repair requires inventivestrategies to mobilise or deliversignificant numbers of progenitorcells to sites of injury and securetheir survival, or to stimulateneighbouring cardiac precursorcells to multiply, integrate, andcouple with spared myocardiumand enhance myocardial function.

While those strategies are veryappealing, a major question iswhether we have the knowledgeand tools to implement them atthis stage in clinical practice, at anequitable cost-benefit?

Initial trials of autologous bonemarrow cells focusedunderstandably on safety andfeasibility both in patients withacute myocardial infarction (AMI)and chronic ischemia and reportedenhanced recuperation of LVfunction. However, by virtue oftheir design, these studies werenot randomised, or lacked a propercontrol population undergoing theexact same interventions aspatients receiving cell transfer.Subsequent double-blind, placebo-controlled randomised trials ofautologous bone marrow celltransfer in myocardial infarctionpatients have shown augmentedrecovery of global LV function after

999 patients) confirmed anoverall benefit, above andbeyond state-of-the-art therapy.

While the absolute increase inglobal function recuperation mayseem modest at first glance, itrepresents an incrementalimprovement of almost equalmagnitude as the initialtherapeutic effects of primarycoronary revascularisation.Moreover, we now haveconvincing data from the largestrandomised double blind studythat a delayed strategy of celltransfer offers the greatestbenefit and that it is almostexclusively observed in patientswith a significant reduction inmyocardial function at baseline.

These insights will help tofacilitate strategies whereby cell-based treatment algorithms arereserved for patients sufferingthe largest infarcts and wherecell transfer can be establishedaccording to the highestscientific standards. Indeed,quality assurance of allstem/progenitor cell isolatesrequires significanthaematological expertise, andhas been shown to have a majorimpact on clinical results in earlyexploratory trials.

At this stage, while safety hasbeen uniformly reassuring, proofof clinical efficacy (improvedsurvival and reduction of heartfailure) awaits larger multi-centreoutcome trials that are presentlybeing designed. To implementstandardised, SOP-based cellisolation, and characterisationprotocols, haematological andcell culture expertise fromexperienced institutions,including central blood bank orRed Cross laboratories or bonemarrow transplant centres, willbe indispensable.

Finally, enabling suchtreatment at an affordable costwill require intense collaborationbetween translational scientists,physicians, healthcareadministrators, and private andpublic health insurancecompanies.

Before cell therapy After cell therapy P

n = 50Pat.

LV-Ejection fraction, % 55±10 63±11 <0.01

Stroke volume inex ml/m2 48±18 53±17 0.05

EDV, ml 173±55 160±48 n.s.

EDV Index, ml/m2 87±30 85±25 n.s.

ESV, ml 80±34 61±29 <0.005

ESV Index, ml/m2 40±17 32±15 <0.005

Ejection fraction

Stem cell application


C A R D I O L O G Y

intraatriell

intramuscular

The body itself containsnaturally occurring, adultautologous stem cells, e.g. inthe bone marrow. They are anethical resource of cells that iscompletely safe. The idea wastherefore to regenerate heartmuscle clinically, bytransplanting naturallyoccurring bone marrow stemcells into the infarcted region.This process was developed inDusseldorf.

Bone marrow was removedand the cells prepared, then,after re-opening the infarctedvessel by balloon dilatation,they were injected into it underlow pressure, using a balloontechnique. The vessel was keptopen with a catheter (aprocedure lasting about 30minutes), during which timetwo to three ml of a suspensionof stem cells were injected intothe infarcted region, a processrepeated with four to sixinsufflations. The interventionwas carried out on consciouspatients with local anaesthesia,and at most produced mildpain at the site of injection.

Follow-up controls for threeyears and longer after theinfarction show that long-lasting improvement in cardiacfunction has been achieved,with an average increase incardiac function of 50% and areduction in the size of theinfarct of about 20%. At thesame time, blood supply to thecardiac muscle has beenconsiderably improved, as hasmetabolism, and physicalstrength has increased. As yet,no side effects have beenreported, so the procedureshould be considered anethically safe treatment ofmuscle loss after infarction, andcausal therapy that is reallybeneficial to the patient.

The Dusseldorf results havesince been confirmedworldwide. Work groups inFrankfurt, Hanover andRostock have been able toshow, even in larger studies,that regeneration of infarctedcardiac muscle can be achievedby transplanting autologousbone marrow stem cells. Whatis important is that thismyocardial regeneration,which, depending on studydesign, is between 4–16%, is ofan order of magnitude that is atleast as great as the sum of alltherapeutic improvements inventricular function achievedwith balloon dilatation or stentimplantation for cardiacinfarction. Consequently, addedimprovement in patients’ventricular function can thus beachieved, on top of surgical

Fig. 5: Long-term evolution of theankle/arm indexes before and after stemcell therapy. Improvement after six monthsaverages up to 30%

intervention and drug treatment.No complications from the stem cell

treatment have been reported so far.There is no malignant degeneration as thecells used occur naturally in the body. Nosigns of inflammation have beenobserved, nor have disturbances tocardiac rhythm, angina pectoris orrespiratory distress. Complications arisingfrom the procedure itself are much thesame as those that might occur inordinary heart catheterisation procedures,and are insignificant.

It should be mentioned that a similarprocedure is also effective in treatingperipheral arterial disease. In this case,treatment involves intra-arterial andintramuscular injection of autologous

bone marrow stem cells into the limbsaffected, the therapy first practised byBartsch et al. Ischaemic preconditioning,such as by compression induced with acuff, or even ergometry, greatly promotesmigration of stem cells into the muscles.

After three months there was markedimprovement in the length of stride, theankle/arm indexes, oxygen saturationand even venous occlusionplethysmography parameters.Consequently, autologous stem celltherapy can also be classed as asuccessful procedure for peripheralarterial occlusive disease, wheresymptoms are refractory to treatment,and in advanced stages of vasculardisease.

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C A R D I O L O G Y

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C A R D I O L O G Y

The Lifebridge B2T (bridge-to-transport) is the first,fully portable emergency lifesupport system for patients

suffering cardiogenic shock, orthose showing signs of imminentcardiogenic shock. The machineensures circulation and sufficientblood oxygenation can berestored in just minutes, thuspreventing multi-organ failureleading to death. Whether inhospital or an ambulance, apatient can be connected to theLifebridge to replace externalcardiopulmonary reanimation.

First introduced in 2005 (seeEH 3/2005), this equipmentrecently received a CE markallowing sales across Europe. Itssmall size (61 x 45 x 37 cm), lowweight (17.5 kg) and power supplyvia integrated battery make itideal for ambulant use. The partly

Platinum chromium alloyenhances designBoston Scientific Corporation has commenced enrolment of a targeted1,500 patients for the Taxus Perseus clinical trials, planned to take placein 100 international centres. The aim is to evaluate the firm’s third-generation paclitaxel-eluting coronary stent - the Taxus Element Stent.This stent features the proprietary Platinum Chromium Alloy (designedspecifically for stents) which, combined with a new stent design, isdesigned to allow thinner struts, increased flexibility, and a lower profile,while improving radial strength, recoil, and radiopacity, Boston Scientificreports, adding that the stent’s platform incorporates new balloontechnology, intended to improve on the firm’s Maverick Balloon Cathetertechnology.

Dean J Kereiakes MD is principal investigator for the trials and MedicalDirector at The Christ Hospital Heart and Vascular Centre and The LindnerResearch Centre, in Cincinnati. Louis A Cannon MD, of the Cardiac andVascular Research Centre of Northern Michigan in Petoskey, is co-principal investigator.

Dr Kereiakes predicted: ‘This new platform, designed for improveddeliverability, should allow us to bring the long-term proven performanceof the Taxus Stent to even the most complex and challenging anatomy.’

The first of the two-part study, called Taxus Perseus Workhorse, willevaluate the safety and efficacy of the TAXUS Element Stent comparedwith Boston Scientific’s first generation drug-eluting stent (TaxusExpress2). 1,264 patients with ‘workhorse’ lesions from 2.75 to 4.0millimetres will be evaluated, with the primary endpoint of target lesionfailure (TLF) at 12 months; its secondary endpoint is in-segment percentdiameter stenosis at nine months.

The second part, the Taxus Perseus Small Vessel study, will comparethe Taxus Element Stent with a historic control (the Taxus V de novobare-metal Express Coronary Stent System). It will involve 224 patientswith lesions from 2.25 up to 2.75 millimetres. The primary endpoint ofthe small vessel study is in-stent late loss at nine months, and itssecondary endpoint is TLF at 12 months. Study success is dependent onboth endpoints, Boston Scientific explains.

Hank Kucheman, Senior Vice President and Group President,Interventional Cardiology, said: ‘The platinum chromium alloy and newballoon technologies in this system are also being developed in anEverolimus version and is intended to serve as foundational technologyin Boston Scientific’s dual-drug DES portfolio, including a drug-elutingbifurcation stent and next-generation Everolimus- and Paclitaxel-elutingstents.’

Ready for action: The 17.5The world’s firstportable, plug-and-play system toprovide hours ofemergencycardiopulmonarysupport is now onsale in Europe.EH correspondentHolger Zorn reports

guided, partly automated set-upmeans that in five minutes it isready for use by emergencydoctors or paramedics – withoutneeding a specialised technician.

To avoid air embolisms, sevensecurity steps guaranteemaximum patient protection.Access to the patient is either bypercutaneous puncture andinsertion of cannulae in vesselsin the groin or, afterthoracotomy, via insertion ofcentral cannulae into the rightatrium and rising aorta.Depending on the access, bloodcirculation of six litres perminute can be achieved, avolume that ensures adequategas exchange and sufficientperfusion of all importantorgans.

The German Heart Institute in Berlin tested the Lifebridge

during elective routineprocedures in bypass surgery.The objective of those trials wasto demonstrate the quality of thenew, portable system comparedwith a traditional heart-lung-machine. The Lifebridge ran forup to 103 minutes (average: 82 minutes). Under conditionstypically found in this kind ofheart surgery, with completecardiac arrest and no ventilation,the machine facilitated sufficientblood circulation to the organsand adequate gas exchange.Therefore, the Lifebridge alsocan be used pre-emptively duringrisky cardiac surgery (e.g. high-risk PCI).

In an earlier experimental studyat the University of Cologne,cardiac surgery using theLifebridge was simulated usingpigs. The animals’ blood gaseswere kept constant during theentire length of the study. Theblood circulation remainedconstant even when the heightdifference between the machineand heart was changed. Injectionof up to 100ml of venous air alsodid not reduce blood flow, andeven the most disadvantageousconditions did not result in anarterial air embolism (source:Mehlhorn U et al., Ann ThoracSurg 2005; 80: 1887-92).Gap in supply of technology forthe treatment of cardiogenicshock can be filledAnnually, hundreds of thousandsof Europeans suffer heart attacks,

STENTING MONITORINGAt the launch a panel of experts discussed the merits of portability

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ATRIAL FIBRILLATION MONITORINGFIRST EUROPEAN AF PATIENTS RECEIVE LONG-TERM, CONTINUOUS MONITORING DEVICE

The Netherlands - The firstimplant of the Reveal XT, aninsertable cardiac monitor madeby US firm Medtronic, whichrecently received CE (ConformitéEuropéenne) Mark, was carriedout in June by Professor Karl-Heinz Kuck MD, at the AsklepiosKlinik St. Georg in Hamburg,Germany.

Medtronic reports that this isthe first insertable cardiacmonitor to offer long-term andcontinuous monitoring of atrialfibrillation (AF): ‘All othercurrent monitoring tools areeither for a limited period or onan intermittent basis. Long-term,continuous monitoring meansthat a clinician no longer needsto rely only on incomplete datato evaluate how AF may beprogressing or treatmenteffectiveness,’ the firm points out.

As is well known, treatment ofAF is difficult because episodesoften show no symptoms and cango unnoticed by patients. ‘Atrialfibrillation is the most frequentcardiac arrhythmia. It is oftenaccompanied by symptoms that

are very unpleasant for thepatient,’ said Prof Kuck.‘Additionally, atrial fibrillation islinked with increased mortalityand an increase in the incidenceof stroke, by a factor of two- toseven-fold. However, with thenew Reveal XT, atrial fibrillationcan now be scrutinised over aperiod of three years with asubcutaneous monitor. This givesus totally new possibilities formonitoring and adjusting thetreatment.’

During its three-year activity,the device is reported to monitorAF patients 24 hours a day.

Up till now there has been nomethod to gather detailed data,over an extended period, on theprogression of AF and the effectof treatment. Reveal XT isexpected to give new insight intopatients’ heart rhythms, whichmight help physicians to evaluatestroke risk and determineappropriate treatment andtherapy options for their patients,Medtronic suggests.

ImplantationThe Reveal XT is inserted justunder the skin, and there is noneed for wires or sticky pads tokeep it in place. The patient issaid to experience no restrictionsin daily activities and, becausecardiac data is recorded duringthe patient’s normal routines thereal-life information obtainedcould provide important insight

to this condition. The medical devices manu-

facturer Medtronic, Inc.(www.medtronic.com) is based inMinneapolis; its European officein the Netherlands.

New remote monitoringfeature for implantablecardioverter-defibrillators(ICDs)The company also recentlylaunched a remote monitoringfeature for ICDs, which haveproved effective (98% of casesreported) in patients sufferingrecurring ventricular arrhythmias.

These patients have needed tohave device check-up’s two tofour times annually, as well asunscheduled visits in criticalsituations, Medtronic points out,adding that its new CareLinkNetwork system will enablehome-monitoring, with internet-transmission of data fromimplanted cardiac devices. To dothis, the patient holds a smallantenna over the device andinformation on how their heartand ICD are working istransmitted to a secure physicianwebsite for a virtual checkup.

‘This technology,’ said PeterSteinmann, Medtronic’s Vice-President for Western Europe,Cardiac Rhythm DiseaseManagement, ‘opens up thepotential for more efficientchronic disease management andbetter outcomes.’


C A R D I O L O G Y

More women than men die of cardio-vascular disease (CVD) every year, yetfemales receive only 33% of angio-plasties, stents and bypass surgeries;28% of implantable defibrillators, and36% of open heart surgeries.

Looking at this situation, Abbott,which produces the Xience VEverolimus Eluting Coronary StentSystem, is involved in a clinical trial -in Europe, Asia-Pacific, Canada andLatin America – to study the stent’ssafety and effectiveness in womenpatients who have untreated coronaryartery lesions.

The first patient to enrol in the trial,called Xience V Spirit Women, hasbeen operated on in Argentina, byLiliana Grinfeld MD, at the ItalianHospital in Buenos Aires, Argentina,who reported that the stent systemhad performed well, and that thepatient will be checked for up to fiveyears.

Abbott reports that the trial willfocus on ‘…specific aspects ofwomen’s health in relation to coronaryartery disease, such as general aware-ness about the disease, symptoms attime of presentation, referral patterns,and hormonal menopausal status.’

The trial’s principal investigator,Marie-Claude Morice MD, at theJaques Cartier Institute, in Massy,France, commented that it is ‘tragic’that women amount to just 25% ofparticipants in all heart-relatedresearch studies, and added that thetrial had the potential to enhanceaccess to CVD therapy by increasingtheir and their physicians’ awareness.

kg heart-lung machine

Trial to raiseawareness ofgender and CVD

caused by the occlusion ofcoronary vessels followingcoronary heart disease. To avoiddeath or lasting damage a patientideally needs to receive treatmentwithin ‘the golden hour’.However, according to datasupplied by MITRA, Germany’sheart attack register, in thatcountry alone, the time lapsebetween heart attacks and start oftreatment is on a continuousincrease. Between 60,000 and65,000 patients do not survivetheir heart attacks (source: MarkB et al., Dts Aerzteblatt 2006;103: A 1378). Cardiogenic shockkills around 20,000 people. ‘Upto 50% of those patients couldsurvive if they received fastmechanical, extracorporealcirculation support,’ points outProf Zerkowski of BaselUniversity, Switzerland.

Ideally, artificial circulatorysupport should begin duringtransfer to a specialised hospital,because vital vessels and organsneed sufficient blood supply toavoid irreversible damage causedby hypoperfusion. However,mobile emergency systems are notusually used during a transfer,because currently availableequipment does not meetrequirements for portability andquick, safe use. ‘Filling this gap inthe supply is of utmost urgency,’said Prof Ruediger Lange, directorof the Cardiovascular SurgeryDepartment, German HeartCentre, Munich, during asymposium held during a market

launch for Lifebridge. Inspecialist centres, heart-lungmachines used during cardiacsurgery must be set up and runby trained perfusionists. Theirsize and weight make themunsuitable for mobile use. Apatient in cardiogenic shock,according to Lange, needssupport for cardiovascularfunction by a lightweight, fast,easy to use machine, which can

be used anywhere. The situation for hospital

treatment is similar. Cardiogenicshock develops in 7 – 10% of allinfarctions, and it isunpredictable. In such anemergency, currently, doctorsmainly use intra-aortic balloonpump counterpulsation (IABP),left-ventricular assist systemsalong with conventional heart-lung machines (HLM). However,

the former can only be used if theheart muscle has remainingfunctionality. In the case of acute,complete cardiac arrest, theimmediate use of a heart-lungmachine is necessary.

Even ultra-modern,percutaneous heart-lungmachines, which are connected tothe patient’s circulation via theiliac vessels during externalcardiopulmonary reanimation,can only be used after 15–20minutes. In addition, because theydepend on manual operation, usererrors and air embolisms cannotbe eliminated.

Therefore, a fully-integrated

‘click’n’run’ heart-lung supportsystem is an urgent requirement,said Prof Zerkowski.

Lifebridge Medizintechnik AG(founded: 1999) has found amarket niche with LifebridgeB2T. With 22 employees, the firmis supported by Bavarianfinanciers and an investmentbank in the United ArabEmirates. It reports that therehas already been strong demandfrom hospitals for this portableheart-lung device, and ManfredSalat, Chairman of the Board,predicts that, as from next year,the Lifebridge should be able tofinance further growth internally.

N E W S

Research Projectin Telemedicine

PARTNERSHIP FOR HEART


C A R D I O L O G Y

In Germany, approximately 1.5million people suffer from chron-ic cardiac insufficiency. Veryoften, the insidious symptoms arerecognised too late, leading tocomplications and hospitalisa-tion. ‘Partnership for the Heart‘is a joint project by science,industry and healthcare systemled by the Berlin Charité andaiming to develop a telemedicalearly warning system. The systemmonitors patients 7/24 at homeand a mini-computer records alltherapy-relevant vital parame-ters.

Body weight is an importantrisk indicator. A sudden increasein body weight for example mayindicate beginning water reten-tion in the body. Seca designedscales for this project based onthe floor scale seca 867. An inte-grated RS232 interface and a

A non-invasivemeasurement of

arterial wallatherosclerosis

By Thaddeus Chodakauskas BSRDMS and Steve Feinstein MD FACC

Non-invasive ultrasound imaging techniquescontinue to provide a major role in diagnosis andmanagement of patients with cardiovascular disease.The early presence of atherosclerosis predates majorclinical events such as myocardial infarction andstroke. Over the last 17 years, the ultrasound-basedmeasurement of carotid artery intima-mediathickness (c-IMT) has become a standard forassessing arteriosclerosis and is recommended by theAmerican Heart Association for the non-invasiveassessment of cardiovascular risk.

Carotid intima-media thickness is defined as thedistance between the lumen-intima interface and themedia-adventitia interface, which corresponds to theinner and outer echogenic lines seen on the B-modeultrasound image. (Fig.1). Measurement of c-IMT istraditionally performed with the image of the carotidartery in the longitudinal axis, revealing the commoncarotid artery, the carotid bifurcation, and theinternal and external carotid arteries. Although thesemeasurements have been performed for years,significant variability exists when measuring the nearwall due to technical and acoustic difficultiesencountered when imaging the c-IMT of the nearwall.

Due to those technical limitations, clinicalmeasurement of c-IMT using B-mode ultrasound isoften applied to the far (posterior) wall of thecommon carotid artery. With the development ofnon-invasive imaging technologies, ultrasoundmethods can be used to reliably measure intima-media thickness (IMT). This measurement serves anon-invasive marker of arterial wall atheroscleroticdisease. Studies have found that, on average, basedon gender and age, the intima-media thickness willincrease 0.01-0.03mm per year. (See tables onhistorical clinical studies of c-IMT).

Figure 2: 50-60 data points

Figure 3

Figure 5

Figure 6

Figure 1: Intima-media wall thickness

If the IMT measurement result is acceptable, select‘Transfer’ in the measurement Carotid folder. The resultswill be displayed in the worksheet and in the final report.

Performing IMT measurement on the Vivid 7 and Vivid i:• Select Measurement key on the keyboard.• Select from the measurement menu carotid folder, then

CCA IMT, to identify the right or left carotid artery,then CCA IMT Post, for posterior wall.

• Position the IMT cursor above the intimated wall, thenpress select key to anchor the first cursor. Repositionthe second cursor using the trackball then press selectkey to anchor the second cursor.

• Approximately 50-60 data points is an adequatesample when used to measure the intima-mediathickness.

Imaging common carotid artery

• Maximise the depth selection and optimise the gainsettings to visualise the posterior intima-media wall ofthe common carotid artery.

• Attempt to capture the common carotid artery withthe jugular vein to improve visualisation of theanterior and posterior carotid walls.

Measuring c-IMT

• Identify a single frame during the end-diastolic phasebetween the P and Q wave off the ECG trace.

The automated IMT package from Vivid 7/Vivid i: thebenefits• The measurement procedure is not operator dependent

and not as time intensive compared with manual IMTmeasurements.

• The semi-automated technique simplifies the time takento perform the measurement compared with manualmeasurement.

• The improved technology enhances c-IMT precisionmeasurements and increases consistency and reliabilityof the results.

• The methodology is robust, reproducible and buildsconfidence among radiographers and physicians.

Intima-mediaTo perform these studies, radiographers/clinicians usehigh frequency (7, 10 or 12) MHz linear arraytransducers with the Vivid 7 Dimension and the Vivid ito efficiently acquire multiple c-IMT measurementswithin seconds. The semi-automated measurement forintima-media wall is simple, easy and takes less thanfour steps. The physician receives immediate results,which consist of these parameters: maximum, mean,average and number of data points examined. Usingthe software application, the c-IMT measurement canbe exported directly to a worksheet and report pageand, subsequently, placed in the patient’s medicalrecord.

BlueTooth module allow smoothtransmission of the values to theCharité’s telemedical centres orthe Robert Bosch Hospital inStuttgart. Blood pressure andECG are determined in a similarway.

Specialist physicians monitorthe values around the clock andinitiate appropriate actions whenneeded – they inform the patientand the family physician or theemergency medical service.

Since the telemedical earlywarning system is considered aviable alternative to currentoptions it is being supported by the German Ministry ofEconomics. The government con-tributes 5 mio. EUR, the sameamount is made available by theindustry partners.Further information: www.partnership-for-the-heart.de

Tips: c-IMT measurements for the Vivid 7 Dimension/Vivid i

Intima-media

Media-adventitia

Jugularvein

Commoncarotidartery

BetweenP and Qwave

FRED® easyportis a Life-SaverCardiac infarction and cardiovascular failure are two of today’s most frequent emergencies.SCHILLER’s FRED® easyport® pocket is the onlypocket defibrillator in the world. It is so small(133x126x50 mm) and light (490 gr incl. battery)that for many doctors it is already standard equip-ment in their emergency bag. It is also suitable toaccompany risk patients and their relatives aroundthe clock.

This life-saver is always available to give doctors,paramedics and rescue technicians peace of mind inemergency situations.

For example during the World Cup 2006, para-medics on duty at the football stadiums carried outtheir duties with FRED easyport clipped to a beltaround their waist. In Switzerland an entire policedepartment has been equipped with this device tohelp fight against sudden cardiac death.

Patients at risk can easily carry this small defibrilla-tor with them, after they and their families have beeninstructed by their doctor. This dramatically reducesthe response time to treat ventricular fibrillation andtachycardias, giving the patient a much better chanceof survival.

For cardiologists this defibrillator can now also besupplied with a manual shock option, i.e. the doctorcan switch off the AED mode and decide the energylevel and exact moment of defibrillation.

Figure 4


C A R D I O L O G Y

Finland - An increased TWA (T-wave alternans) is a significantindicator of all-cause andcardiovascular mortality, as wellas of sudden cardiac death inpatients with mostly normalejection fraction, according to arecently published study byresearchers led by Dr TuomoNieminen. Until now, this wasonly known as an indicator forthose patients suffering severeheart diseases predisposing tolife-threatening arrhythmias. Inan interview with Meike Lerner,of European Hospital, DrNieminen explained theadvantages of the TWAmeasurement, study results andthe consequences these have forfuture research.

‘The T-wave represents theelectric repolarisation of theheart,’ Dr Nieminen explained.‘Thus, alternans in the T-wave isa marker of an alternatingrepolarisation process, whichmight indicate cellulardisturbances duringrepolarisation. This is important,since pathological repolarisationphase predisposes to ventriculararrhythmias. In general, theTWA measurement could beused for arrhythmic riskstratification, but it is also one ofthe diagnostic criteria for longQT interval syndrome, anotherrepolarisation abnormality.

TWA can be measured with aregular electrocardiogram; noextra examinations are necessary.The possibility to measure the T-wave alternans is a specialfeature within normal ECGsoftware.

There are two methods forTWA assessment: time-domainmodified moving average(MMA) and spectral methods.Both methods seem to measurethe same phenomenom. For ourstudy, we used the GE Health-care software embedded with theMMA method, which can beapplied in routine exercise testprotocol without stabilising theheart rate to any specific level.’ Several studies have proved theeffectiveness of measuring TWAfor prognoses. What makes thisstudy different?‘Essentially all previous studiesincluded patients with an ejec-tion fraction of less than 50 per-cent, which is called abnormal.But in our population this onlyrefers to 13 percent of thepatients.

In 2001, we launched theFinnish Cardiovascular Study(FINCAVAS), in which we enrolall volunteering patientsperforming a clinical exercise testat Tampere University Hospital.We use the standard protocols ofthe bicycle ergometer test, withan increasing load every minute.This TWA analysis aimed to testwhether TWA predicts mortalityin our study population. Theresults of the study show that theTWA measurement providesprognostic value also in patientswith a normal ejection fraction.’ What consequences do thesefindings have for patients’treatment?‘Our results suggest that TWA

identifies patients prone to sud-den cardiac death at an earlierstage of cardiac disease thansupposed before. It is the firstbut naturally important step toshow that a certain marker isassociated with mortality.Another equally important stepwill be to test whether the

patients with such a patholog-ical marker will benefit fromtreatment options, such asanti-arrhythmogenic pharma-ceuticals, or an ICD implant.The results of our study didnot answer that latter part,which is a big question for thefuture - studies are being

TWA predicts mortality in patientswith normal ejection fraction

planned and conducted to reachthat goal.

We need to bear in mind thatestimating the aggregate risk forsudden cardiac death should bebased on several parameters.No single marker will suffice,but TWA seems to be a verygood candidate to be involved!’

Dr Tuomo Nieminen,Tampere University Hospital


C A R D I O L O G Y

MolecularmedicineA weapon to beat high-risk plaque

Paul Smit

The high riskplaque initiative THE BASIC STUDYThis will take place in twomobile units, located in a num-ber of large cities in the USA.The design of the study and theprotocol development is beingformulated in a close collabora-tion with BG Medicine, whichwill develop the blood-basedbiomarkers, and with leaders invulnerable plaque research fromleading Universities in the USA,Denmark and the Netherlands,as well as with partners Merckand Astra Zeneca.

The first patients will bescanned in the autumn of 2007,and the complete bio-imagingstudy will take about one year.While the complete set of imag-ing data will be ready in morethan a year - the study will takeabout four years.

It has only recently beendiscovered that very often itis not the size of the plaquein the coronary vessels but

its inflammation status thatdetermines the occurrence of acardiac infarction. Thisknowledge triggered newresearch approaches for its earlydiagnosis and treatment incardiology – for example theHigh-Risk Plaque Initiativejointly founded by PhilipsMedizin Systeme, AstraZeneca,Merck & Co, BG Medicine andHumana, which focuses on thepossibilities that molecularmedicine now offers. Theresearchers are trying to identifysuitable biomarkers that allowthe early diagnosis and targetedtherapy of inflamed, so-calledhigh-risk, plaque.

In molecular medicine, theHigh-Risk Plaque Initiative isone of the most importantprojects of Philips MedizinSysteme, as Paul Smit, in chargeof strategy and development in

the Dutch company, explained:‘Today, high-risk plaque isrecognised as the major cause ofcardiac infarction which killsabout 50 percent of the patients.This means, in many cases, deathis the first symptom of thedisease. Furthermore, thosepatients who survive the event are

chronically ill and requiremedical care for the rest oftheir lives. This disease is notonly dangerous for the patientsbut also presents an immensefinancial burden on thehealthcare system – a burdenthat will increase steadily overthe next few years. In short,

high-risk plaque is one of themost fatal and one of the mostexpensive diseases.’

In addition, coronary plaque isa highly unpredictable conditionbecause, depending on the degreeof inflammation, the plaquesuddenly ruptures and causes anembolism, which in turn leads to

A T R I A L F I B R I L L A T I O N

Robot moves steadilyin on catheter ablationSensei Robotic Catheter System installed in London

St Mary’s NHS Trust, which wasawarded a ‘good’ performance inthe 2006 NHS performance rat-ings, has 3,600 staff that providesspecialist care for women’shealth, cardiology, children’s ser-vices, infection and immunity androbotic surgery. The Trust reportsthat it has one of the lowest mor-tality rates in the UK, and a ‘richhistory of research, developmentand teaching thriving todaythrough the relationship withinternationally renowned univer-sity partner, Imperial CollegeLondon’.

Dr Wyn Davies set up the elec-trophysics department at StMary’s and also has been praisedby the British Medical Associationfor initiating a ‘day return’ cardiactreatment service in 2001. Withthis service, patients receivetreatment during a day and returnto their local hospital thatevening. This has shortened wait-ing times for beds to becomevacant for their potentially life-saving operations. In addition, hepointed out that returning totheir local hospitals mean rela-tives and friends can visit moreeasily.

The Sensei Robotic CatheterSystem, a first generation roboticplatform launched by HansenMedical at the USA’s HeartRhythm Society ScientificSessions in May this year, is in usein Europe. St Mary’s Hospital, inPaddington, central London,became the World’s first centre ofexcellence for training in anddevelopment of the system, underthe guidance of consultant cardi-ologist and electrophysiologistWyn Davies MD FRCP FHRS. Asof July, over 20 atrial fibrillationpatients had been operated on atSt Mary’s using this robotic surgi-cal aid controlled by the surgeonat a nearby workstation.

The Sensei system and Artisancatheter aim to enable physiciansto easily and accurately placemapping catheters in hard-to-reach anatomical locations withinthe heart with stability, during thediagnostic phase of complex car-diac arrhythmia treatment,Hansen reports.

‘The new robotic system allowsthe operator to perform EP proce-dures in a more consistent fash-ion, which I believe will lead tothe development of a standardapproach for complex diseases,’Wyn Davies observed.

Currently, the majority of clin-icians manually guide cathetersthrough the heart to detect andtreat a variety of cardiac arrhyth-mias. This technique requiresphysicians to perform a series ofcomplex manipulations at oneend of the catheter without assur-ance that the tip of the catheterwill respond as desired wheninside a patient’s heart. Achievingstable contact at anatomic siteswithin the heart, which is essen-tial for successful mapping proce-dures, can be difficult, Hansenpoints out. ‘As a result, insuffi-cient contact between the cathetertip and the inside of the heart wallcan lead to highly variable and

less than optimal procedureresults for the patient. HansenMedical believes its robotic plat-form overcomes these hurdles andwill enable physicians to performprocedures that historically have

been too difficult or time con-suming to accomplish routinelywith existing manual technique.’

The systemThe Sensei system is compatiblewith fluoroscopy, ultrasound, 3-D surface map and patient elec-trocardiogram data. The twomain components that comprisethe system are the Artisan con-trol catheter and an ergonomi-cally designed, remotely-placedworkstation where the physiciansits throughout the procedure. Inaddition to lessening operatorfatigue, the remote workstationcreates a virtual shield for physi-cians against harmful radiation,Hansen added. ’The openarchitecture provided by theSensei system, which allows theuse of pre-approved catheters from third-party manufacturers,requires a labelling additionfrom the FDA. The addition isintended to remind physiciansthat the safety and effectivenessof the system for use with cardiacablation catheters in the treat-ment of cardiac arrhythmias,including atrial fibrillation, havenot been established. The Senseisystem has received CE markapproval in Europe, and theArtisan Control Catheter is cur-rently pending CE markapproval.’

For many patients, a catheterablation is the most effective wayof treating AF; however a short-age of clinicians able to performthese complex procedures con-tributes to thousands living withthe condition and its associatedrisks. In the UK alone, over50,000 people develop AF annu-ally, yet fewer than 10% undergocatheter ablation.

St Mary’s, which runs one ofthe UK’s busiest cardiac centres,is now one of only four hospitalsglobally that are using the Senseirobot. Wyn Davies said it has

Czech Republic – During ameeting of cardiologists inPrague earlier this year toexchange experiences with newmethods and treatments tocontrol atrial fibrillation, DrJosef Kautzner, Head ofCardiology Department atIKEM (Institute of Clinical andExperimental Medicine) pointedout that numbers of patientswith AF will more than doubleduring the next 20 years. In theCzech Republic alone, there areabout 120 thousand peoplediagnosed with AF. All thesepatients have worsened qualityof life, twice the mortality dueto cardiac failure, and a fivetimes greater risk of cerebralvascular accident (CVA) whencompared with the normalpopulation of the same age. AFalso causes about a fourth of allCVAs, which means around fivethousand people are afflicted bythis disease.

The annual treatment of onepatient is 40 thousand CZK, i.e.almost 5 billion CZK (178.5million EUR). Figures for the

UK, according to theNICE guidance, indicatethat, in July 2006, therewere more than 1.4million UK patients withAF (source: NICE costimpact report) consumingsubstantial part of

healthcare financialbudget.

The main goals ofAF treatment arewidely recognised– to renew normalcardiac rhythm,and to ensure thatAF doesn’t occuragain.

Therapeuticmodalities are

wide, apart fromanti-arrhythmics, modern mini-invasive methods are recently onthe rise – cardiostimulators andcardioverters and defibrillators,electric cardioversion andparticularly catheter ablation.

In the Czech Republic, the firstpatient with an implantedcardiostimulator was seen atIKEM back in 1962, and the firstdigital cardiostimulator wasimplanted in 2003 in Prague’s NaHomolce Hospital. Catheterablation as an AF treatment hasbeen in use for quite some time.

With new medical technologyachievements, three-dimensionalimaging has arrived in this scene.New diagnostic approaches allow3-D views inside of the heart, socardiologists can combine thatimaging technique with a cardiacCT scan, and navigate thecatheter through the heart with afull stereometric view.

One of the pioneers in the fieldof even more advanced medicaltechniques is London’s St. Mary’sHospital (see robot feature onthis page).Report: Rostislav Kuklik

Electrophysicist Wyn Davies at the Senseiworkstation

Cardiologistsmeet to sumup progress


C A R D I O L O G Y

a cardiac infarction, or a stroke.This sudden rupture of inflamedplaque in a coronary arteryexplains why 70–75% of cardiacinfarctions occur without priorsymptoms.

‘Hitherto physicians wereunable to determine when theplaque has reached a dangerousstage. Today, molecularmedicine offers the possibility toidentify indicators of theinflammation. The first task ofthe High-Risk Plaque Initiative isto develop a broad patientscreening concept, which wehope will show early indicatorsin patients with infarcts that arenot present in the control group.If we know these earlyindicators, or biomarkers, whichpredict an inflammation, thanksto modern imaging methods wewill be able to locate the high-risk plaque and determine itsvolume,’ Paul Smit pointed out.

The collected data can becombined with statistical valuesand thus provide valuable

information on the patient’scurrent and future risk.Currently, Philips and the othermembers of the High-Risk PlaqueInitiative are developing a testthat will be applied to more than6,000 patients in coming years.

Early diagnosis of high-riskplaque is no doubt a major stepforward. However, it has to leadto targeted therapies for theaffected coronary vessels. Today,physicians are rather powerlesswhen it comes to the treatment ofplaque, since there are novalidated tests to determine theeffectiveness of drugs. However,it appears to be proven that

regular monitoring and ahealthy lifestyle often improve apatient’s condition.

Molecular medicine offerspromising approaches for otherdiseases as well - cancer, forexample. Currently, methods arebeing researched that useultrasound to transportmedication through the vesselsright to the affected bodyregion. The medication isdocked onto micro-bubbles, or acontrast agent, and injected into the body. With the help ofultrasound signals the physiciancan trace the bubbles’ route tothe target region. As soon as the

bubbles reach the affected tissuea certain ultrasound frequencycauses them to burst and theactive agent is released. Becausethe medication is administered ina very targeted way, a muchlower dose than in a systemictherapy is required – whichincreases the therapeutic successand significantly reduces sideeffects. The principle has alreadybeen tested in pre-clinical trialsand is now being developed forclinical use in a joint effort withthe pharmaceutical industry. ThePhilips research team has alreadygone one step further and isworking on finding out whether

this innovative method can beused for cardiac diseases.

‘We are still in the early stageof research into validatedbiomarkers and it will take aboutfour more years before we will beable to identify high-risk plaquewith the help of biomarkers.However,’ Paul Smit concludedoptimistically, ‘thesedevelopments will open entirelynew possibilities from which boththe patients and the healthcaresystem will profit: Early diagnosiscan significantly reduce treatmentand follow-up costs of manydiseases.’Report: Meike Lerner

‘enormous potential to helpdeliver difficult catheter ablationprocedures’. Pointing to theshortage of expertise in the UK,which means there are too fewcentres where highly complexcases can be carried out, headded: ‘With further develop-ment that we are alreadyembarking on, this robot willenable complex procedures to becarried out almost automatically,increasing the opportunities totreat more patients and ultimate-ly reducing clinical risk. Therobot allows accuracy and con-trol of catheter movement whichcannot currently be achievedwithout a skill level that usuallytakes considerable time toacquire. We are thrilled that StMary’s cardiology unit has beenable to pioneer this excitingadvance. With the other surgicalrobotic programmes alreadyestablished at the hospital, St.Mary’s is a world leader in robot-ic medicine.’

Although capable of use in allforms of ablation procedures,Hansen reports that the robotwill predominately be used forcomplex ablation procedures totreat atrial fibrillation.

The Czech Republic andGermany Another chosen centre of excel-lence is the Cleveland ClinicFoundation in Ohio, where thesystem is being used under theguidance of Andrea Natale MD,who is director for the Centre forAtrial Fibrillation, director of theElectrophysiology Laboratoriesand head of the Section of Pacingand Electrophysiology there. Shehad used the Sensei system dur-ing clinical evaluation on 25patients in the Czech Republicand Germany. ‘The stability ofthe Artisan catheter allowed usto perform catheter mappingprocedures more efficiently andeffectively,’ Dr Natale said. ‘Theincorporation of the Sensei sys-tem and catheter did not addtime to the procedures, nor did itrequire increased radiation time,as would normally be expectedwith new technology. As a result,I’d expect this new system tobecome the medical standard forperforming complex EP proce-dures, which are currently limit-ed to those individuals with thehighest level of skill.’Report: Brenda Marsh

© 2007 Cardiac Science Corporation

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Düsseldorf, Germany

14–17 November 2007

39th World Forum for MedicineInternational Trade Fair with Congress

Messe Düsseldorf GmbH Postfach 1010 0640001 DüsseldorfGermanyTel. +49(0)211/45 60-0 1Fax +49(0)211/45 60-6 68www.messe-duesseldorf.de


N E W S

the German electrical and electronics industry– will present light signalling solutions.Bluetooth SIG, a co-operation project ofhigh-tech companies that include Nokia,Intel, Microsoft and Toshiba, will highlightapplication possibilities of Bluetoothtechnology in healthcare institutions.

Highlighting advances in teleradiologyalso will continue, as willtelecommunication between doctors andpatients, particularly the chronically ill.

All this, and more innovations for in-and out-patient care, including electromedicine and medical technology,laboratory technology and diagnostics,pharmaceuticals, physiotherapy, textiles,medical furniture and equipment, willbe on show.

Among the forums, e.g. MEDICAMEDIA and MEDICA MEET IT, thePhysiotherapy Forum is likely toattract physiotherapists in droves.

Anyone who’s somebody inmedical manufacturingheads for the MEDICAtrade fair held annually inGermany with 4,200

exhibitors from 65 countries at theshow, as well as 320 more atCompamed, which runs alongsideMEDICA to present manufacturerswith everything from new materials,components, pre-products, packagingand services to complex micro systemsand state of the art nanotechnology.

Similarly medical professionals andthose in hospital procurement flock tothis, the biggest event of its kindinternationally, to keep abreast ofinnovations and take a hands-onapproach. Last year these visitorsnumbered 137,000.

Again this year MEDICA will holda sharp focus on networks andcommunication. For example,members of ZVEI - the association of

Not to be missed!14 –17

NOVEMBER2007

MEDICA & Compamed 2007

DAILY:Latest research news fromvarious medical disciplines

and medical industry

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MONTHLY:Editorial topics and specials

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www.messe-duesseldorf.de

Compamed 2007 –the trend is eversmaller

Microtechnology and nanomedicine enable ever smaller and more mobile solutions in medicaltechnology. Moreover, the show’s organisers point out, telemetrics in product development is here to stay. They cite implantology as an example. ‘In thefuture, implants will be fitted with acceleration sensors and a telemetrics module that detect sub-optimal positioning. Such innovative sensor technology may also act as quality assurance forimplanted hips and knees as it helps to recogniseunfavourable implants and thus avoid radiationexposure during X-rays.’

‘Smart Fabrics andInteractiveTextiles’(SFIT)European Hospital has featuredsome of these developments in previ-ous issues, and it’s worth noting that,in 2006, this market was alreadyworth $340 million. The generalconcept is to develop ‘e-textiles’,which can integrate sensors, actua-tors, communication devices andpower generation devices. Designedas shirts or jackets, a wearer couldbe permanently monitored for med-ical purposes (e.g. blood pressure,blood/oxygen saturation, sweating,skin temperature, heart rhythm).Because the electronic devices will beworn in direct contact with the body,highly flexible systems must bedeveloped to stretch as well as followand react to body movements.

New materialsand newapplications forexistingmaterialsSynthetic materials can beused to create high preci-sion compounds at a rea-sonable cost and even sim-ple materials, e.g. polyeth-ylene or poly-propylene,are being shaped intosophisticated products. Somedical devices are increas-ingly made in syntheticcompounds, e.g. theinhalators through whichpatients can inhale severalactive ingredients, and sodo not need injections.

ACQUISITION

‘Onex finds good companies inattractive markets - and they helpthe companies grow throughinternal investment and byproviding access to funding andexpert guidance on mergers andacquisitions and partnerships,’Kevin Hobert explained. ‘This istheir core capability. So, withOnex, we now have moreflexibility and more opportunity.We can now meaningfullycompliment our portfolio in waysthat are sometimes hard to dowhen you are part of a largepublic corporation.

Onex has been working withus to expand and refine ourstrategy, to build on our greatproducts and services and ourcustomer relationships and groweven faster. I can’t go into all ofthe specifics, but the Onex teamis a very smart group of peoplewith a lot of good ideas. Theacquisition has been a great fitfor our team.

Our change to an independentcompany does not change ourfundamental approach to servingour customers, but when theyhave unmet needs or new ideas, itgives us a few more ways that wecan go about satisfying thoseneeds and delighting ourcustomers. We have beenworking on a number of verycreative ideas that will provideoutstanding solutions for ourcustomers. Some of these ideasare things we just wouldn’t havebeen able to do in the past.

Carestream Health is‘, he said,‘fundamentally changing itsportfolio. Our solutions help ourcustomers to dramaticallyimprove the cost and quality ofcare through the transformationfrom film and paper to an all-digital workflow. And within thisarea we have been, and will be,pursuing a number ofinnovations. For example, newX-ray detection technology todramatically improve the wayour customers replace film, newprocess capability and newconsulting solutions that are

Health imaging and IT solutionsfirm predicts greater flexibility

Recently, as a result of the acquisition of Kodak’s Health Group by Onex Corporation,Carestream Health Inc. began operations as one of the world’s leading independenthealth imaging and IT solutions companies. We asked Kevin J Hobert, CEO ofCarestream Health, about this and its effects on his company’s operations

enabled by the technology weprovide, and innovative newclinical tools. We have also beeninvesting areas such as imageprocessing and rendering toprovide dramatic advancement inworkflow and quality. Theseinvestments will result ininnovative products in the years tocome.

the world. Very few companieshave the global presence thatenables a large investment inproduct development. In our casenearly two thirds of our revenuecomes from outside the US, whichis proportional to the globalmarket opportunity.

Our film business also has greatmaterial science and coating

clinicians and drive decisions willhappen very gradually, over time.But it is very exciting.

Western Europe and the UnitedStates are definitely at theforefront of the implementation ofdigital technology - I think Europemore so at an enterprise level, orcountry level. Having nationallymanaged healthcare gives many

Film, now and tomorrow We want to lead our customersfrom film and paper to an all-digital workflow and help themimprove their quality and costthrough that transition,’ KevinHobert pointed out. However, headded that film is still veryimportant to the firm. ‘Film is agreat business and provides greatcash flow that allows us to investvery aggressively in our digitalbusinesses. Globally, ourrelationships with our filmcustomers provide us with agreat starting point, becausethese are the customers thatwe’re helping through thetransition. Our history in filmmeans that as we bringinnovative new solutions to themarket we build on relationships,that have been cultivated for thelast 110 years, with tens ofthousands of customers around

assets, and a great team – thepeople who built the medical filmbusiness – and this team andthese technologies can serve otherindustries. Our team has alreadybegun coating products forpeople in other industries, whichalso provides a new area ofgrowth for us. I’m sure we’ll beable to continue to provideoutstanding film at a reasonablecost, because our team and ourmanufacturing assets are fullyutilised.‘

Asked when he thinks hospitalswill become fully digital, hepointed out that, in some, it isalready happening. ‘Around theworld it will take quite a bit oftime to really get the full benefitsof being all-digital,‘ he added.‘Taking all of the data across theenterprise and turning it intoclinically useful information andinsights that help inform

European countries a greatopportunity to get some of thebroader community benefits ofdigital healthcare. But somedeveloping countries are alsomaking major investments intechnology and, by building onthe experience of more developedcountries, are delivering caremore effectively to rural markets.We are seeing innovation allaround the world.’

Molecular imaging ‘Our growth this year has beenstrong, particularly on the digitalside of molecular imaging; wenot only provide films andphosphors, but also digitalimaging systems and imagingagents – an area that is growingvery rapidly. This year weintroduced a number of high endin-vivo imaging systems, andthese are multi-modality imaging

systems with integrated X-ray,radio-isotopic and optical imaging.We focus on optical molecularimaging and provide full solutionsthat include both the imagingsystem and the imaging agents.

We are building on more than 50years of dye, chemistry andnanotechnology experience gainedfrom manipulating very, very smallparticles used in film formulations.As a result we offer non-cytotoxicprobes with superior brightnessand photo stability. Our experience working with thesesmall particles has allowed us todevelop probes that are small anduniform and have unique surfacestructures - and that don’t damagethe body in any way. So, ourimaging agents can translate veryrapidly from research to clinicaluse. This is all part of our imagingheritage. We have fantasticintellectual property and have beenable to bring these very powerfulprobes to market very quickly andoffer solutions with probe, dye and imaging system together.We’ve had good success withresearch institutionsinternationally, and with researchdepartments within pharmaceuticalcompanies.

With our optical molecularimaging product, a pharmaceuticalcompany can see immediatelywhether or not a therapy they’redelivering is having an effect.Rather than, in the case of tumourtreatment, waiting weeks ormonths to detect a difference intumour size, a researcher can seeimmediately, at cellular level,whether or not a treatment iseffective. This really streamlinesdrug development and clinicaltrials. And again, the great thingabout our technology is that ittranslates from clinical studies intoclinical use.

We couldn’t be more excitedabout our future,’ Hobertconcluded. ‘We now have anincredible opportunity to build onour history of innovation and toinvest in our future and grow ourbusiness.’

Up to 230 participants discussedIT solutions at tis year’s venue:Schloss Waldthausen near Mainz

Germany – 74% of DICOM-CDs from 87 differentmanufacturers do not comply with current standards,according to a joint study by OFFIS (OldenburgerForschungs- und Entwicklungsinstitut für Informatik-Werkzeuge und -Systeme) and the DeutscheRöntgengesellschaft (DRG), presented at the recent9th HIS-RIS-PACS and DICOM Meeting*. Five percentof the CDs were also found to be defective and, of theremaining 21%, less than half met the requirementsfor DICOM-CDs. ‘Most problems are caused by non-compliance with file or path naming conventions andby missing attributes,’ Michael Onken of OFFISexplained.

of 99.91%, he added, making the popular and expen-sive 24/7 full-service contracts entirely obsolete.

A further issue are the unclear legal implications ofcompressing and storing angiography data from multi-slice CT. In addition, they discussed the transmission ofslices of sub-millimetre thickness that requiresimmense bandwidth and unnecessarily prolongs work-flow.

The integration of non-DICOM images in to PACSmade another focal point. Internists, dermatologists,ophthalmologists can now see the value of digitalarchives so would like to store their images in PACS, forassignation to an electronic patient record (EPR).Whilstin Germany this is still being discussed, other Europeanusers have progressed – e.g. the Son Llatzer Hospital inPalma de Mallorca, Balearics, has found an impressivesolution for multi-media patient files based on a PACS.

IT FORISTANBULTurkey - The recently opened 74-bedFlorence Nightingale KiziltoprakHospital, which has three operatingrooms and 10 ICU beds, is one of fourhospitals in a Turkish healthcarenetwork. GE Healthcare reports thatit has equipped the hospital’sradiology department with the firm’sdiagnostic imaging products 3T MRSigna HD and the LightSpeed VCT, aswell as mammography and ultrasoundsystems.

To manage the massive increase ofradiology patient data and imagesthe brand-new hospital has alsoadopted GE’s Centricity RIS/PACS. ‘Thesystem provides ultra-fast imagedisplay and storage, extended 3-Dreview possibilities, a speechrecognition system and online-dashboards, resulting in seamlessworkflow and faster treatments,’ GEpoints out.

With a total 13 Centricity RIS/PACSworkstations, Dr Mustafa Sirvanci, inthe Radiology Department, said thatimages from the Florence Nightingalecan now be shared remotely via theweb, as and where required, withother hospitals within the network.

* The meeting was organised by the workinggroup @GIT of the Deutsche Röntgengesellschaft(DRG) with the co-operation of the Akademie fürFort- und Weiterbildung in der Radiologie (afurther education school for radiology), andsupported by IHE Deutschland, OFFIS and theJohannes-Gutenberg University in Mainz.

investing in expensive SAN (Storage Area Network),NAS (Network Attached Storage) or CAS (ContentAddressed Storage) solutions, the physicist and radi-ologist recommends purchasing two inexpensiveRAID systems, each of which proves uptime of 97%.Mathematically this solution offers atotal system stability

At the event experts familiar with hospital andgeneral practitioner (GP) working needs looked atsoftware systems from various perspectives – in par-ticular the challenge of data exchange. This not onlymeans online, but also via CD exchange, all of whichpresent enormous obstacles.

Physicist and radiologist Dr Reinhard Loose, of theInstitute for Diagnostic and Interventional Radiologyin the 1,100-bed North Nuremburg Hospital, sur-prised the audience - and particularly manufactur-ers’ representatives - when he said that PACS is notan enterprise-critical application there. ‘A discussionwith 40 clinical department heads of our hospitalindicated that a PACS failure in no way impedes clin-ical workflows,’ he said, and explained that all imag-ing specialists there use local buffer stores, where alldata can be stored for several days. Distribution ofimages to individual departments and wards isensured by a dedicated web server. Rather than

Most DICOM-CDs donot meet standards


I T & T E L E M E D I C I N E

Kevin Hobert

HOSPITALIUM INTERNATIONAL HEALTHCARE PLATFORMRegistration and Query FormIf you wish to register your healthcare facilities and medical specialities on theHospitalium Platform, or would like to receive further information about thisinternational concept and/or membership fees, please fill in this form and sendit to: EUROPEAN HOSPITAL Verlags GmbH, Theodor-Althoff-Str. 39, 45133Essen, Germany

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I T & T E L E M E D I C I N E

Preliminary results from an inter-national study to evaluate the useof radio-frequency identification(RFID) as a hospital risk manage-ment tool in medical care, havebecome available from the studyleaders at the Hospital Manage-ment Centre, Munster University,and dreiH Consulting, based inMainz, Germany.

Andreus Hagen, owner ofdreiH, who based his masters the-sis at Munster University on thissubject, describes radio frequencyidentification (RFID) as ‘…anauto-ID process that allows auto-matic and contactless identifica-

AN INTERNATIONAL STUDY TO EVALUATERADIO-FREQUENCY IDENTIFICATION

of the higher degree of automa-tion future generations of elec-tronic pharmaceutical cabinetswill no doubt turn to RFID,because it provides an automaticand contactless check of the RFIDstaff ID. If a drug or other objectis fitted with a RFID transponder,the cabinet’s technology will auto-matically check and register dataon who took what and when fromthe cabinet and will issue neworders when necessary. Unlikebarcode technology RFID doesnot require the object or ID cardto be physically moved towardsthe barcode reader.’

left the hospital, the data wereread and transmitted to a centraldatabase. Should someone con-tract SARS, every one of theircontacts could thus be tracedand isolated, to prevent SARSspreading.

RFID limitations? In a preliminary research report,Wilfried von Eiff, AndreasHagen, Alexander Prangenbergpoint out that when adoptingRFID technology for patientcare, staff should be involvedearly on in the planned work-flow changes, and proper train-

Boost to global health tourism predicted

Hospitalium – a web platform company – is launching a new ‘one stop’healthcare website to connect patients with leading medical institutions andspecialists worldwide.

The concept is seen as a big step towards boosting global tourism, becausepatients will be able to directly source the medical help they need; have adirect dialogue with specialists, and decide for themselves which medicalcentres could provide the best treatments for their particular illnesses.

‘Offering a unique platform to enable video chat integration with hospitalsinternationally is a 21st century breakthrough in healthcare. It will be achievedby initiating free health consultancy services with leading providers of differentspecialties,’ explained Hatice Yurtsever, International Manager of Hospitalium.‘Our objective is to connect everyone in the world with all the hospitals via oneonline platform, which will give people the opportunity to keep up to date withthe world’s latest health technology. In return, individuals and hospitals willalso receive the latest updates; patients and doctors can have online videochats and online appointments can be made.’

Services will not only include 24-hour online communication betweenpatients and hospitals, but also individual health packages.

Registration If you wish to promote contact between your healthcare establishment andpotential new patients, simply fill in the Hospitalium Registration Form. As youwill see, requested information includes the special medical services providedby your hospital, as well as the name(s) of the physician(s) appointed toanswer online questions.

All your information will be processed into the Hospitalium web portal forpatients to access and assess, and they will have the option of discussing theirmedical questions with your online doctor, during the consultation hours youspecify, or to make an online appointment to attend your hospital.

In addition, your various medical services and health packages will beadvertised on the international Hospitalium.com portal, accessible worldwide,to attract patients seeking specific treatments.

Pointing to the Hippocratic oath which commits doctors to help all people,Hatice Yurtsever added a message for medical specialists and hospitals:‘Hospitalium.com also swears that it will put hospitals and patients togetherregardless of age, race, gender, language, disability, creed or sexual orientation.We are now living in the 21st century, it’s time to reach out and get healthy.’

HOSPITAL SECURITY

Left: Professor Wilfried von Eiff, Managing Director of the Centre for Hospital Management(CKM) and Director of the Hospital Management Institute (IKM) at Munster UniversityCentre: Andreas Hagen MBA, owner of dreiH Consulting (www.dreiH.com), which adviseson modern quality management, integrated risk management and innovative technologies(e.g. RFID). He is also project manager and in-house consultant for process and IToptimisation for the METRO GroupRight: Alexander Prangenberg, Project Manager at CKM and research associate at IKM

tion of objects and persons. RFIDsystems are made up of atransponder, a read/write deviceand a back-end software applica-tion. Unlike a barcode – whichcan only be read out by an elec-tronic device upon visual recogni-tion of the code – a RFID systemcalls up data from a transponder,or written to a transponder, with-out visual or physical contact.Depending on the frequency, thetransponder, the read/write deviceand other specifications, the read/write process can bridge a dis-tance from a few millimetres toseveral metres.’

RFID applications in healthcarecould include the identification ofpeople, equipment and medicaldevices, pharmaceuticals and lab-oratory samples, blood, etc, hepoints out. An analysis of the cur-rent use of 161 installations ofRFID applications in the health-care sector, by consultancy firmIDTechEx has shown that RFID isused most often in areas wheremix-ups must be avoided; whereexisting processes need to be auto-mated and where reprocessing ofmedical products and clinical tex-tiles must only take place a certainnumber of times.

Giving as an example the elec-tronic pharmaceutical cabinetsthat control prescriptions and dis-pensing, Andreus Hagen adds thatsome hospitals in the USA alreadyuse cabinets from suppliers spe-cialising in RFID technology,although most still uses barcodesfor drug tracking and finger print-ing technologies for staff identifi-cation. ‘For hygiene reasons –RFID is contactless – and because

Patient ID

Patient associations in the US, UKand Germany consider correctpatient identification a corner-stone of patient safety, he adds,and in German speaking coun-tries, the potential value of RFIDfor patient safety is increasinglyrecognised. A number of RFIDpilot projects have proved thatusing RFID for patient identifica-tion can greatly improve patientsafety, he says. These projectsinclude dementia (senior citizenhome Langelsheim), support ofcorrect medication (SaarbrueckenHospital, Jena University Hos-pital), the central operating the-atre (Innsbruck University Hos-pital), blood samples and bloodtransfusion (St Gallen DistrictHospital).

Monitoring contacts with highlycontagious diseases During the SARS outbreak in theFar East, wristbands fitted withactivated RFID transponders wereissued in Singapore to patients,visitors and staff at the AlexandraHospital. Every encounter closerthat two metres, between twopeople, was recorded and storedon the wristbands. When anyone

ing should be provided in the useof the devices. ‘The effects of theimplementation of new tech-nologies have to be carefullyanalysed and evaluated in pilotprojects. A process analysis anda Critical Incident and ReportingSystem (CIRS) that is acceptedby the staff are crucial. Par-ticularly a thorough post-imple-mentation analysis of CriticalIncidents is required as this isoften the only tool for the earlydetection of new risks.’

The team also recommends a combination of technology(RFID), organisation (fitting thewristband which is marked withthe name of the patient) andhuman control (asking thepatient for his/her name) to pro-vide the highest possible safety.‘If a patient or a family memberis unable to respond and thetechnology fails, there is at leastthe name tag to provide identifi-cation.’

In conclusion: ‘Due to theirhigh degree of automation, RFIDsolutions integrated in systemimmanent security (Poka Yoke)and process optimisation sys-tems may contribute greatly andcost-efficiently to hospital riskmanagement and patient safety.

‘Although barcode and RFIDare not necessarily mutuallyexclusive but can complementeach other well, the successfulintroduction of RFID in medical-clinical processes will depend onthe penetration rate of barcodesand on the degree to which thecurrent advantages of the bar-code technology will prevail.’

** To participate in the onlineRFID Survey 2007 visit the CKMwebsite: http://www.ckm-consult(Projekte) orhttp://www.rfidhospital.de.

A N N O U N C E M E N T

RFID applications in healthcare

Application Objective/ remark Frequency

People Mostly patient identification to avoid errors, 42%as well as staff identification (tracking, alarm)

Medical equipment Theft protection for valuable goods, 17%and devices avoiding misplacement and allowing

quick tracking

Pharmaceuticals and Tests and one roll-out in 2005 to avoid 29%laboratory samples counterfeiting, one large-scale application

and many tests for error avoidance

Blood Mostly error avoidance 6%

Others Access cards, tags and passes, patient files 6%and reimbursement. Supply chainmanagement (logistics) with pallets, boxesand pharmaceutical cabinets

Source: Based on Harrop/ Das/ Holland, IDTechEx (2006)

NEW INTERNATIONAL WEBSITE COULD LINK YOURHOSPITAL WITH POTENTIAL PATIENTS WORLDWIDE


N E W SR E S P I R A T O R Y M E D I C I N E

The European Respiratory Society(ERS) Congress is the world’sbiggest annual scientific gatheringin respiratory medicine. This year,after a five-year absence, it returns to Stockholm, a cityfamous for its Nobel prizes and Karolinska Institute(whose researchers contributed to 11 EuropeanRespiratory Journal original articles in 2006). TheCongress is augmented by the world’s leadingexperts in this field. 17,240 delegates from over 100countries attended the 16th ERS annual Congress inMunich last year.

This year there will be 40 Symposia; 20 ‘Hot Topic’ symposia and‘Grand Rounds’; free communication sessions, including 86 oralpresentation sessions, 64 poster discussions, themed posters andelectronic poster sessions; 23 postgraduate courses, oneeducational and 18 ‘Meet the Professor’ seminars, as well asevening symposia held by industry.

The important role of primary care in respiratory health serviceprovision will also be highlighted in a ‘Primary Care Day’ on 15September. The programme has been endorsed by theInternational Primary Care Respiratory Group and the SwedishRespiratory Group in Primary Care.

The European Board of Accreditation in Pneumology (EBAP) willallow European pneumologists to apply for Continuing MedicalEducation credits.

15-19SEPTEMBER

2007

The ERSCongress

By Professor Giovanni BattistaMigliori MD, Director of the WHOCollaborating Centre for Controlof Tuberculosis and Lung Diseases

Principles of tuberculosis controland eliminationTB control is a public health functionaimed at reducing the transmission ofTB bacilli in the general population.

Presently, at global level the TB noti-fication rate is still growing at an aver-age 1% per year, largely the result ofthe constant increase of cases in sub-Saharan Africa and, to a lesser extent,in the former Soviet Union with a sig-nificant prevalence of multi-drug-resis-tant (MDR –TB) and extensively drugresistant (XDR-TB) cases.

XDR-TB is a new, severe form of TBpresently defined as resistant to atleast rifampicin and isoniazid (which isthe definition of MDR-TB), in additionto any fluoroquinolone, and to at leastone of these three injectable drugsused in anti-TB treatment: capre-omycin, kanamycin and amikacin.

In January 2006 the new Global Planto Stop TB, 2006-2015 was launched.The plan, underpinned by the Stop TBStrategy, describes strategies, financialrequirements and existing gaps toreach the Millennium DevelopmentsGoals (MDGs) in all regions of theworld.The new Stop TB Strategy forTuberculosis Control and itscontribution to control andeliminate tuberculosisThe DOTS strategy (composed of fivekey elements: government commit-ment, diagnosis through sputum smearmicroscopy, standardised and super-vised treatment, uninterrupted drugsupply, and regular programme moni-toring) has greatly contributed toimproved global TB control over thelast 10 years.

However, due to a variety of reasons,DOTS has not been sufficient to controlthe epidemic in the two regions ofAfrica and Eastern Europe. This is whythe new Stop TB Strategy promoted bythe World Health Organisation, whilekeeping DOTS as the first and foremostof its six components, has made explic-it five additional components thatmust be implemented to reach the2015 MDGs relevant to TB: 1) pursuehigh-quality DOTS expansion andenhancement; 2) address TB/HIV, MDR-

TB and other challenges; 3) contributeto health system strengthening; 4)engage all care providers; 5) empowerpeople with TB and communities; 6)enable and promote research.International standards for TBcareThe International Standards forTuberculosis Care (ISTC) have beendeveloped as a tool that can be used toimprove the quality of care across allproviders, public and private. The ISTCare intended to facilitate the effectivedelivery of high-quality care for allpatients regardless of age or gender,and including the ‘complicated’ cases,those who are sputum smear-negative,have extra-pulmonary sites of disease,and those who are affected by MDR-TB,or co-infected with HIV. They aredesigned to put the patient at the cen-tre of care and the healthcare providerat the centre of TB control. The docu-ment includes six standards for diagno-sis, nine standards for treatment andtwo standards addressing public healthresponsibilities.

The ISTC emphasises, among otherissues, that TB diagnosis should bepromptly and adequately established,based, whenever possible, on bacterio-logical evidence. Standardised treat-ment regimens of proven qualityshould be prescribed, with appropriatetreatment support and supervision. Theresponse to treatment should be moni-tored and microbiological examina-

tions performed. The essential publichealth responsibilities should be carriedout, including evaluation and manage-ment of close contacts as well as casenotification and reporting of treatmentoutcomes.ISTC, private sector and scientificsocietiesAlthough the ISTC is evidence-basedand widely accepted, it is only a tool,not an end in itself. To achieve adher-ence to the standards in the ISTC it iscritical that they have sufficient ‘weight’to wield influence and be disseminatedto relevant practitioners. This can bestbe achieved by having broad endorse-ment of influential medical and nursingprofessional societies, both national andinternational and that these societiesthen develop educational activitiesbased on the ISTC. Of key importance isthe close collaboration with the nation-al TB programme and the synergisticattempt to include the ISTC among thebasic tools required for the properimplementation of public-private mix(PPM) DOTS approaches.ConclusionsThe epidemiologic evidence indicatesthe specific new challenges for tubercu-losis control in Europe.

The ISTC document is aimed at stimu-lating the global effort in the fightagainst tuberculosis starting from thequality management of each individualpatient by each individual physician.Contact: [email protected]

Peter Ickert (seated with Daniela Zimmer-mann) joined Hutchinson Inc as MarketingDirector for Europe six months ago; he is nowGeneral Manager for Europe

New monitoring device for France & Germany – Traumapatients are being more and moremonitored with a novel portabledevice to measure oxygen satura-tion in tissue. Called the InSpectraStO2 Tissue Oxygenation Monitorit was developed by the Minneso-ta-based firm Hutchinson Inc,previously best known for themanufacture of computer compo-nents. Daniela Zimmermannasked Peter Ickert, Hutchinson’snewly appointed General Manag-er for Europe, about this productshift. ‘Since the company is spe-cialised in measuring processesand production techniques, aboutten years ago we decided to moveinto medical technology,’ heexplained. ‘The company hassince carried out numerous clini-cal studies to validate the qualityof its products in practical appli-cations.’

The novel monitor, which mea-sures oxygen saturation in tissuewith near-infrared spectroscopy, isone of these. ‘The conventionalnon-invasive device, the pulseoximeter, measures only thehemoglobin oxygen saturation inthe arteries. However, our prod-uct measures the oxygen in thetissue,’ he pointed out. ‘The cru-cial question when measuringoxygen saturation is: Does theoxygen get to the point where it isneeded, namely the tissue?’

Study results have demonstratedthat StO2 measurements of lessthan 75% might indicate serioushypoperfusion in trauma patients.The firm reports that the monitoris the only tissue oxygenation

monitor designed for trauma envi-ronments, that provides a direct,absolute measurement of haemo-globin oxygen saturation in tissue(StO2), which provides traumateams with those vital measure-ments and continuous monitoringduring resuscitation. It uses nearinfrared light to illuminate tissue,then analyzes the returned light toproduce a quantitative measure-ment of oxygen saturation in themicrocirculation.

The InSpectra is primarily tar-geted at the trauma and emer-gency medicine market. ‘In thatsegment it’s above all the bleedingpatients who benefit from it. In atrauma situation it’s very difficultto determine whether a body issufficiently perfused. This issomething that ultimately requiresan invasive procedure and delaytime in obtaining lab results’ heexplained. ‘So a fast and non-invasive device, which on top of

Non-invasive monitoring of By Paolo Montuschi MD, of the Department of Pharmacology, Facultyof Medicine, Catholic University of the Sacred Heart, Rome, ItalyThe pathophysiological role ofinflammation in lung diseasesincluding asthma and chronicobstructive pulmonary disease(COPD) is well established. Quan-tifying lung inflammation is rele-vant for the management of inflam-matory airway diseases as it mayindicate that pharmacologicalintervention is required beforesymptom onset and reduction inlung function. Moreover, monitor-ing of airway inflammation mightbe useful in the follow-up ofpatients with asthma and COPD,and for guiding pharmacologicaltherapy. Quantification of pul-monary inflammation is currentlybased on invasive methods includ-ing the analysis of broncho-alveo-lar lavage (BAL) fluid, bron-choscopy, and bronchial biopsies,semi-invasive methods such as spu-tum induction, and the measure-ment of inflammatory biomarkersin plasma and urine, which arelikely to reflect systemic rather thanlung inflammation.

Interest in the identification of non-invasive biomarkers forinflammatory airway diseases hasbeen growing. These biomarkersshould identify those patients whoare more susceptible to the disease;reflect the degree of pulmonaryinflammation and the diseaseseverity; be reproducible in stableclinical conditions; be suitable forrepeated measurements in the lon-gitudinal follow-up of the patients;be elevated during exacerbations;be useful for monitoring pharma-cological therapy; and be of prog-nostic value.

Exhaled breath consists of agaseous phase that containsvolatile compounds (e.g., nitricoxide, carbon monoxide, andhydrocarbons) and a liquid phase,termed exhaled breath condensate(EBC) that contains aerosol parti-cles in which several non-volatilecompounds have been identified.Measurement of exhaled nitricoxide (NO) is a well accepted,standardised, validated and widelyused method for assessing airwayinflammation in patients with asth-ma who are not being treated withinhaled glucocorticoids. Measure-ment of exhaled NO is rapid,reproducible, and provides imme-diate results. Concentrations ofexhaled NO in patients with asth-ma correlate with sputumeosinophil cell counts and airwayhyper-responsiveness before gluco-corticosteroids. One portableanalyser is commercially availableand can be used to assess and mon-itor airway inflammation in

patients with asthma on field.Sputum induction is a semi-inva-

sive method for assessing airwayinflammation. This technique hasbeen standardised. Sputum analy-sis for evaluation of percentage ofsputum eosinophils directly mea-sures airway inflammation, and isone method of objectively monitor-ing asthma. However, althoughgenerally considered safe, sputuminduction with hypertonic salinesolution can cause bronchocon-striction, particularly in patientswith airway hyper-responsiveness;can induce airway inflammation byitself; can be difficult to perform,particularly in children and inpatients with severe asthma orCOPD; requires dedicated staffand equipment and processing ofsamples within two hours fromcollection.

Recently, attention has focusedon EBC as a non-invasive methodfor studying the composition of air-way lining fluid. Using urea, whichis a freely diffusible molecule, as amarker, it has been demonstratedthat a measurable fraction (1 in 24parts) of the EBC in healthy sub-jects is derived from aerosolised air-way lining fluid. EBC analysis ofinflammatory biomarkers is a non-invasive method that has the poten-tial to be useful for monitoring air-way inflammation in patients withrespiratory diseases, including chil-dren. As it is completely non-inva-sive, EBC also is suitable for longi-tudinal studies and to monitor theresponse to pharmacological thera-py. Furthermore, different bio-markers might reflect the differentaspects of lung inflammation oroxidative stress, which is an impor-

Prof. G B Migliori is co-ordinating several nationaland international researchprojects on TB and asthmacontrol for the Italian Ministryof Health, the World HealthOrganisation and the IUATLD(International Union Against

Tuberculosis and Lung Disease).His experience and activities in the field aretoo extensive to list. They include importantcontributions to the new Ugandan NationalHealth Information System. Since 1995, hehas been a Consultant of the World HealthOrganisation (in charge of TB control) withsignificant contributions to approaches inRussia, Romania, the Ukraine, Moldova,Turkey, Kosovo, Estonia, Mozambique andItaly.

In 2000, he became Director of the WHOCollaborating Centre for Tuberculosis andLung Diseases and, from 2003, Head of theClinical Epidemiology Service of RespiratoryDisease, Fondazione Salvatore Maugeri, Care& Research Institute, Tradate, in Italy.Prof. Migliori is presently co-ordinatingseveral national and international researchprojects on TB and asthma control for theItalian Ministry of Health, the WHO and theIUATLD (International Union AgainstTuberculosis and Lung Disease).He is the author of the European Guidelinesfor TB control and co-author of the mainguidelines on TB control resulting from theIUATLD/WHO workshops (Wolfhezedocuments), and is Associate Editor of theEuropean Respiratory Journal, and prolificcontributor to other specialist journals.

Setting internationalstandards for TB care

Stupid people always make the samemistakes, intelligent people learn fromtheir own mistakes; wise peopleobserve others and learn from them.Global player, Metsä Tissue has madethis pearl of wisdom their own andanalysed the market in full includingcompetitors and users. Further, in theEuropean study research was made notonly into the standard of toilet today,but also the expectations of the publicas how they would like toilets to be.

Europe-wide the standard ofcleanliness of toilets is most severelycriticised where there are hygiene andhealth implications. This is caused by alack of expert knowledge on the part ofthe decision makers, with regard toactual facts and their ensuing effects interms of using suitable dispensers andapparatus and above all from usingpoor quality paper which ‘produces’poor cleanliness. The corollary to thisnegativity is that the service providerhas, in most cases, users who turn uptheir noses (customers, own staff) and ahigh infection risk and high servicecosts (cleaning & maintenance).

‘These deficits in the washroomsof health service, industry, inoffice buildings, orgastronomy, could all be athing of the past’, says FrankLedosquet, Metsä Tissue’sMarketing Manager for CentralEurope, happily. ‘We are proudthat our paper quality is good, butwe needed to upgrade our dispensersand toilet accessories. With our newKatrin dispenser series, toilets can fromnow on be fitted out accordingly with

water splashes. The dispenser’s body ismade of robust ABS plastic and can bequickly cleaned. It can be easily seenthrough the integral window how fullthe dispensers are. A further distinctivefeature is the choice of lock function.This new series can be changed fromlockable to openable dispenser with justa turn.

The user-specific diverse rangeincludes different dispensers for papertowels, toilet paper, soap (in acompletely closed system), hand washfoam, air fresheners, (for the first timewith 100% anti-allergic contents), aswell as a new type of disinfectant foamin a dispenser for toilet seats.

It is important to note that manyfunctions can be operated without directcontact, which maximises the standardof hygiene and minimises risk ofinfection. Furthermore, this newdispenser generation is the perfectcombination of the appropriatedispenser and paper quality for theindividual situation and is a guaranteeof the highest economic viability.

The results have shown that a 50%reduction can be seen, not only in usage,but also in storage and wastage.Likewise, the refilling time can bereduced by from 30% up to potentially75%.

Free information about what, inyour property, can increasequality and at the same timereduce costs, is available from:Metsä Tissue GmbH,Bahnhofstrasse 60, D- 59379Selm- BorkPhone: +49 (0) 25 92/ 66- 0Fax: +49 (0) 25 92/ 66- 169E- Mail:[email protected]

HYGIENE

Wisdom


R E S P I R A T O R Y M E D I C I N E

Paolo Montuschi MD

perfusion monitoring

everything provides continuousreading, is crucial for thosepatients. The InSpectra generatesreliable results in only 20 seconds,which means that some trips tothe lab are no longer necessary.The device continuously recordsthe values in two-second intervals,so that the oxygen saturation his-tory in the tissue can be tracked.So, it’s currently for use through-out trauma care.

‘Unlike in the US, in Europethat includes emergency response,because here the trauma patientreceives complete first treatmentat the accident site.’

So the device is part of theambulance equipment, thenmoves into a hospital with thepatient and emergency doctor?

‘Yes. InSpectra is part of the

airway inflammation in asthma and COPD

tant component of inflammation.Identification of selective profiles ofbiomolecules in different inflamma-tory airway diseases might be rele-vant for differential diagnosis inrespiratory medicine. Collection ofEBC samples is simple, not expen-sive, and safe. However, unlikeexhaled NO measurement, EBCtechnique does not provide real-time results as EBC samples need tobe assayed for different biomole-cules. Several methodologicalissues, including standardisation ofEBC technique and validation ofanalytical methods, need to beaddressed before this approach canbe considered for applications inthe clinical setting.

This article discusses the advan-tages and the limitations of mea-surement of exhaled NO, analysisof sputum eosinophils, and analy-sis of EBC in patients with asthmaand COPD, and provides sugges-tions for further research in thisarea.

Measurement of exhaled nitric oxide In some centres, measurement ofexhaled NO is now available as aroutine test for asthmatic patients.This method is useful in the diag-nosis of asthma, can be used tomonitor the response to inhaledglucocorticoids in patients withasthma; can predict asthma exacer-bation and can be used to monitorcompliance. Exhaled NO concen-trations in patients with asthmadecrease rapidly after anti-inflam-matory therapy and are elevatedduring exacerbations. With the useof exhaled NO measurements,maintenance doses of inhaled corti-costeroids may be significantlyreduced without compromisingasthma control.

Data on the concentrations ofexhaled NO in patients withCOPD are controversial. Oneimportant limitation of measure-ment of exhaled NO in thesepatients is that exhaled NO isstrongly affected by NO content incigarette smoke and most of thepatients with COPD have a smok-ing history.

The clinical utility of exhaledNO measurement is currently lim-ited to patients with asthma, as itsrole in the management of otherrespiratory diseases, includingCOPD, is not yet defined.

Analysis of eosinophils insputum inductionTailored asthma interventionsbased on sputum eosinophils canreduce the frequency and severityof asthma exacerbations in adultswith asthma. For this reason, spu-tum eosinophil analysis has been

proposed to adjust and monitorasthma therapy for adults with fre-quent exacerbations and severeasthma. The utility of adjustingasthma therapy based on sputumeosinophils compared with tradi-tional methods (primarily clinicalsymptoms and spirometry/peakflow) in children with asthmaneeds to be established.

Although neutrophils and mac-rophages are generally consideredto play the major pathophysiologi-cal role in COPD, up to 40% ofpatients with COPD have sputumeosinophilia. Analysis of sputuminduction might be useful for iden-tifying phenotypes of COPDpatients. These patients are gener-ally relatively resistant to glucocor-ticosteroids. However, improve-ment in lung function and symp-toms concomitant with a reductionin sputum eosinophil counts areobserved in patients with COPDwith high baseline sputumeosinophilia, after treatment withinhaled or oral glucocorticos-teroids. The response to glucocorti-coids in this subgroup of COPDpatients does not seem to be solelydue to an asthmatic component, assputum eosinophilia is not neces-sarily correlated with reversibilityto bronchodilators and the latter isnot associated with steroid respon-siveness. However, the role of spu-tum induction in patients withCOPD has yet to be established.

Exhaled breath condensateanalysisSeveral biomolecules have beenidentified in EBC and found elevat-ed in patients with asthma and/orCOPD including hydro-gen per-

oxide, 8-isoprostane, leukotrienes(LTs), prostaglandins (PGs), nitri-tes, nitrates, and nitrosothiols. Inmost of the studies, biomoleculesin EBC have been measured withcommercially available immunoas-say kit, which require validationwith reference analytical tech-niques. The presence of 8-iso-prostane, LTB4, PGE2, glutathione,and aldehydes in EBC has beendemonstrated by mass spectrome-try analysis. pH values in EBC arereduced in patients with acute asth-ma and stable COPD.

Measurement of pH in EBC iseasy, rapid, and provides immedi-ate results. However, some vari-ables including the effect of ambi-ent CO2 and oral bacteria need tobe considered. Most of the studieson EBC are cross-sectional. Thereare relatively few interventionalstudies aiming at measuring bio-molecules in EBC and they are allsingle centre studies. The lack ofstandardised procedures and vali-dation of analytical techniques iscurrently the main limitation ofEBC analysis. Guidelines for mea-surement of biomolecules in EBCare available, but their usefulness islimited by the fact that manymethodological issues still need tobe formally addressed. Moreover,each biomarker in EBC needs to beconsidered separately and thismakes it the standardisation of thistechnique more complex. However,considering the relative lack ofnon-invasive methods for monitor-ing airway inflammation and the-rapy, and the relevance of its po-tential applications, additionalresearch on EBC analysis is war-ranted.

the correct dispensers for each type ofapplication and with the right paperquality all harmoniously matched’.

The product diversity of the Katrindispenser range makes it possible forevery washroom to be customised.There are several holes on the back ofthe new dispensers, making it easy toreplace without drilling other holes.The back plate and screws are out ofsight and therefore protected against

emergency chain, at presentprimarily in intensive careunits (ICUs) and shock rooms.However, in Germany andFrance we are in the process ofevaluating the system in ambu-lances and emergency doctors’vehicles.

The emergency market isquite saturated, so who, inparticularly would want theInSpectra?

‘Everyone who wants toknow whether a patient’s tis-sue is sufficiently saturatedwith oxygen and whether thatsaturation is not being com-promised by unrecognisedhaemorrhages. The traumateam can only react in time ifthis is known - and with thehelp of this device it can reactmuch earlier than before. Weoffer continuous measurement,which means changes can berecognised in real-time – andnon-invasively! That meansthe device can be used on thespot, by an ambulance team.’

In that field of application itis necessary to get readingsfast. How was that solved?

‘Yes, time is crucial. Ourprocedure is very simple: youjust have to apply a sensor tothe patient’s thenar eminence –and that’s something everytrained trauma team membercan do.

Contact:[email protected]; More information:www.htibiomeasurement.com

ConclusionsMeasurement of exhaled NOshould be used for assessing airwayinflammation in patients with asth-ma, whereas its utility in patientswith COPD is limited. Analysis ofsputum eosinophils can be used totailor and monitor anti-inflamma-tory therapy in asthmatic patients.This technique might contribute tothe identification of COPD pheno-types with important therapeuticimplications for patients withCOPD. However, sputum inductionis unlikely to become a routinetechnique for assessing airwayinflammation. Identification ofselective profiles of biomarkers inEBC and the pharmacological mod-ulation of their concentrations inthis biological fluid might haveimportant diagnostic and therapeu-tic implications for patients withasthma and COPD. However, dueto the current lack of standardisa-tion, whether and when EBC analy-sis will be applicable to the clinicalsetting is difficult to predict.

As both asthma and COPD areheterogeneous diseases charac-terised by different phenotypes, thecombination of different non-inva-sive and semi-invasive techniques,including measurement of exhaledNO, sputum induction, analysis ofEBC, and possibly, new techniquesusing biosensors for measuring bio-markers in the exhaled breath,could be the best approach forassessing airway inflammation inthe individual patient with asthmaor COPD. For its important diag-nostic and therapeutic implications,this approach might ultimately leadto a better management of patientswith asthma and COPD.

c-Met – the signal molecule thatregulates cell growth and cellmigration during embryonicdevelopment – has been shown toplay a key role in healing in the skin,according to a paper published in theJournal of Cell Biology ( Vol.177, Nr. 1, pp. 151 – 162, 2007) by PhDstudent Jolanta Chmielowiec,working with Professors Walter andCarmen Birchmeier at the MaxDelbrück Centre for MolecularMedicine (MDC) in Berlin, Germany.The research demonstrated that if c-Met is missing in skin cells, no newtissue can form to close a wound.

When the skin is injured, it firstscabs over, sealing the wound.Starting from the edge of the wound,keratinocytes then migrate across thewound, proliferating very quickly torapidly form new skin tissue –hyperproliferative epithelium – whichalso fills the wound with new skincells so that new tissue can replacethe scab.

c-Met regulates this migration


W O U N D M A N A G E M E N T

Diabetic foot syndrome (DFS) is one of the mostserious sequela of diabetes mellitus. DFS, describedin the Wagner classification system by six gradesfrom the initial wound to amputation (Fig. 1–6), isa slowly developing condition that presents a majorchallenge for the medical team, which shouldinclude podiatrists and orthopaedic technicians. InGermany alone, current estimates indicate 29,000diabetes mellitus-induced amputations annually,most of these following an infection – particularlyMRSA. 10% of all diabetics with DFS will undergo a major amputation of the lower extremities, and20% of these patients will not survive the surgicalintervention.

The problem and causes of DFSThe crucial issue with DFS is the sensor and motorpolyneuropathy that affects about 60% of thesepatients. Sensor polyneuropathy reduces pain sensi-tivity, which means the patient or the family noticea weeping wound on the sole of the foot onlybecause socks or shoes are wet. Fairly often, it isonly upon discovery of such a wound and subse-quent consultation with a doctor that the patientrealises s/he suffers type II diabetes mellitus thatneeds treatment. In many such cases the patientshad not paid much attention to their feet and over-looked previous symptoms, such as reduced sweatsecretion, excessively warm, dry, chapped and cal-lous feet and even deformations caused by motorneuropathy. The latter atrophies the short foot mus-cles and causes changes in the form of the plantararch, which in turn leads to a different distributionof pressure when walking and, consequently, to cal-lus formation on the foot where the pressure ismost intense. Often, these physical developmentsare ignored because they are taken as normal signsof ageing. According to a Health Care Monitoringstudy, patients take their bodies for granted, ormaybe fall into one of the following categories:● 21% of adults take only the most basic measures

to maintain health; they consider a visit to thedoctor’s surgery is an easy way out and tend toreject self-medication

● 15% of adults feel healthy; they talk and think lit-tle about their health; they know that their per-sonal healthcare is inadequate but see no pointin changing their behaviour

● 17% of adults are not interested in their individ-ual health; they feel healthy and rarely see adoctor (Source: Health Care Monitoring, aGerman study involving 3,000 people. Details:www.psychonomics.de)

According to this study 46.6% of the adult popula-tion have little or no interest in their health andreact too late to a condition that would haveprompted the other half of the population to see adoctor. This disinterest might explain why so manypatients present with severe medical conditions.

A further consequence of neuropathic disorders isdiabetic neuropathic osteo-arthropathy (DNOAP or‘Charcot foot’), which causes the plantar arch tocollapse, leading to deformities due to increased

Saving diabetics’ feetDisease management programmes (DMP) yield first results

Heidi Heinhold reports

Wagner classification of diabetic foot lesions

Grade Foot lesion

0 No lesion, foot risk, foot malposition,hyperkeratosis

1 Superficial lesion

2 Deep ulcer extending to muscles and ligaments

3 Deep ulcer and infection (to muscle, tendonand bone) with osteomyelitis

4 Partial gangrene

5 Extensive gangrene

pressure and callus formation.About 30% of these patients suffer a combination

of peripheral arterial disease (PAD) and diabetic neu-ropathy, 10% have ischaemia. In both cases theprognosis is even worse than for neuropathy due tothe vascular situation and poor circulation. Vasculardiagnostics and reconstruction are imperative – afact that underlines the necessity for close coopera-tion between diabetologists and vascular surgeons, ifthe patient is to have a chance to avoid amputation.

Even better: the patient can be convinced to par-ticipate in a disease management programme(DMP).

In Germany, such programmes have shown verypromising results. In December 2006, the first dataanalyses to provide an indication as to the effective-ness of DMPs became available. In one GermanFederal State the condition of 44,995 patients withtype II diabetes mellitus were recorded for sixmonths (April to September) in 2006, and the studyshowed that very few cases of diabetic keto-acidosishad been reported. This means that diabetics inGermany are quite well prepared to avoid this dread-ed life-threatening metabolic disorder. After all,30.1% of them could get rid of typical diabetessymptoms, such as fatigue, polyuria and polydipsia(excessive thirst). High blood pressure was undercontrol in almost 40% of them. 92.9% of thepatients underwent a foot examination but only48.6% participated in diabetes training.

These figures show that the education issuerequires much more attention. This might well be themost difficult task for the medical team: The patienthas to understand that he will benefit from that edu-cation and learn to control the disease and its con-sequences rather to be controlled by it.Source: Phasengerechte Versorgung beim DiabetischenFußsyndrom, Coloplast GmbH, Hamburg)

Healing skin woundsResearchers define the role of signal molecule c-Met

Cells responding to a skin wound. Those in the upper row have functioning c-Met, which reproduce quickly andmove to the wound area; in 48 hours the site contains a large number of these cells. In the lower row many cellsdo not have c-Met; these respond much more slowly. Only those cells that have c- Met enter the wound region

1

process from the edge of the wound.It is a receptor molecule alsolocalized on epithelial cellmembranes.

Professor Carmen Birchmeier andher research team have studied therole c-Met plays in developmentalbiology for several years. Interactingwith c-Met is a growth factor namedhepatocyte growth factor/scatterfactor (HGF/SF) because it wasfound to be a growth factor inhepatocytes (liver cells). The liverregenerates particularly quickly afterinjury. In cancer research, this factoralso plays a key role as scatter factor,which Professor Walter Birchmeierand his colleagues demonstratedrepeatedly.

The duo HGF/SF and c-Met iscrucial in regulating cell migration.Together, the two are not onlyreleased in the liver, but also in thelung, the kidneys, and the heart whenthese organs are injured. As MDCresearchers were able to show, this isalso the case with skin wounds:

JOLA

NTA

CHM

IELO

WIE

C©

MDC

0

2

3

4 5


W O U N D M A N A G E M E N T

The German firm Hartmann reportsthat Hydrotul, its new hydrocolloidimpregnated dressing, combines thebenefits of conventional impregnateddressings with those of hydro-activewound dressings. ‘Whilst the ointmentkeeps the wound margins soft and sup-ple and prevents macerations, the car-boxymethyl cellulose (CMC) particlesintegrated in the ointment mass form ahydroactive gel when in contact withthe wound exudate. This creates amoist wound environment to promotewound healing, and prevents the

A deeper view of wound infectionsLaunched last year, the WoundInfection Institute (WII),supported by Smith & NephewWound Management, now has a130-strong membership, whichinclude leading clinicians andscientists working to understandmore about wound infectionsand their control. ‘Woundinfection scares me on a dailybasis,’ says Professor KeithHarding, Chairman of theInstitute and Director of the

The hydro-activewound dressing

Wound Healing Research Unit inCardiff, Wales. ‘Increasing ourknowledge of why a wound isinfected and how we may best beable to treat it is fundamental forour future.’

The institute aims to develop acomplete reference source forwound infection for use by anyclinicians who need to check oncurrently available treatmentsand related manufacturers’claims. ‘Ultimately, it is hoped

that the major references will beabstracted and graded in terms ofthe evidence available,’ theinstitute points out.

In June 2008, a consensus paperon wound infection, one of sixkey projects initiated by theorganisation’s executive body, willbe launched at the World Unionof Wound Healing, and theInstitute will hold its first annualgeneral meeting, when it expectsto have completed and launched

all those projects via its website. When it becomes a self

governing body, clinicians willprovide original work withinthree core areas: evidence,education and research.

WII membership is open toclinicians, infection controlspecialists, educationists,scientists or people in relatedindustries.E-mail for details:[email protected]

HGF/SF and c-Met are increasinglyreleased by the hyperproliferativeskin tissue. Hence, this tissuepromotes its own growth. However,while c-Met is normally found inboth the skin and the hair follicles(and in wounds is increasinglyreleased in the hyperproliferativeepithelium), HGF/SF is proven tobe present prior to injury in thehair follicles but not in the skin.HGF/SF is not active in the skinuntil after an injury at which time itis particularly active at the woundedges of the hyperproliferativeepithelium.

With a special technique, theMDC researchers specifically de-activated the gene for c-Met inmice. They discovered that micewhose skin cells no longer producec-Met do not form new skin whenthe skin is injured. In mice that stillhave some skin cells with active c-Met, because those cells escaped thegenetic mutation, wound healing isnot blocked. However, it starts laterand takes twice as long as usual.This means that only skin cells withactive c-Met can build up fast-growing, protective new tissue toclose a skin wound. Corresponding author:Walter Birchmeier.E-mail: [email protected]

wound dressing from sticking to thewound. The honeycomb-like structureof the carrier material has large poresfor unimpaired exudate drainage inseverely exuding wounds.’

The firm points out that Hydrotulcan be left on the wound for severaldays to allow a wound to ‘rest’, andadds that an atraumatic dressingchange is possible.Sizes: 5 x 5 cm, 10 x 12 cm and15 x 20 cm.

NEW

RESEARCH

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Phone +49 40 20 00 00 0 . Fax +49 40 20 00 00 50 . www.seca.com

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The products you choose depend on your individual needs – and on those of your patients. seca scales and measuring devices are designed to meet your needs down to the last detail, for example, in cardiology. The digital column scale seca 701 has a capacity of 200 kg with an especially fine graduation of 50 g to a weight of 150 kg. With its cable remote control the floor scale seca 862 is extremely flexible. The seca 861 has practical automatic tap-on and switch-off functions and is therefore particularly power-saving. Therefore, whatever demands you make: you will find your individual solution at seca.

seca 861 – digital floor scale with

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seca 862 – digital floor scale with

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seca 701 – digital column scale with

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29_01_604 AZ EuropHospital09_07_1 1 02.08.2007 13:02:44 Uhr


L A B O R A T O R Y & P H A R M A C E U T I C A L S

In the five halls of this international fairfor instrumental analysis, laboratory tech-nology and biotechnology lab workers willfind just about everything they need. Withthree main exhibition categories – labora-tory technology, analysis and quality con-trol; life sciences and diagnostics for thelaboratory sector – the event drawsaround 1,000 exhibitors (in just thebiotech area there will be around 400). Afew highlights will be sections dealingwith nanotechnology, personalised medi-cine and biochips.Personalised medicine – The effect ofmany medications varies from person toperson. Molecular-biological diagnosticsmakes it possible to tailor therapies topatients’ genetic profiles and modify med-ication dosages to suit an individual’smetabolism. The show will focus on bio-analysis and diagnostics procedures thatpromise to make customised therapiespossible.Biochips – Personalised medicine revolvesaround DNA chips. A micro-array fromEppendorf, for example, will allow physi-cians to determine whether a patientshould undergo radiation or chemo-therapy after a lumpectomy – and whichpatients can skip those treatments. Thebreast-cancer chip has more than 200genes that identify the type and stage of atumour.

Biochips can also be used to improveAIDS therapy. In this case, the virus’ abili-ty to change is problematic because it can

The updated Olympus dotSlide dig-ital virtual microscopy system canscan entire slides at high resolutionand fidelity, making them accessi-ble and fully navigable anywhere inthe world.

Using any of the three models –dotSlide MD (manual); dotSlide SL (fully automated, with slideloader), and dotSlide TMA (with atissue micro-array module) – userscan examine a virtual slide as ifseeing the original through amicroscope. This allows patholo-gists and researchers, for example,to review cases without being neara microscope. Second opinionsbecome quicker, and remote con-sultations, training and discussionpossible, Olympus points out. Thetechnology also provides highthroughput and high content capa-bilities.

The dotSlide models use theOlympus BX51 microscope. Whilstwith the dotSlide MD, slides and

Virtual slide for real analysis

AACC emphasisespreventive diagnostics San Diego, California – 20,000 international physicians, scientists and other visitors travelledto the Annual Meeting & Clinical Lab Expo of the American Association for Clinical Chemistry(AACC) in July, and 750 exhibitors emphasised the increasing importance of this gathering

AutomationAbbott Molecular showed them2000 system, an automated cen-tre for sample preparation and real-time PCR: The m2000sp uses pri-mary bar-coded tubes and precisionpipetting in an open mode, therebyreducing transcription errors. Iteliminates manipulation and pro-vides flexible protocols for varioussamples. The m2000rt real timereader incorporates automatedquality checks and calibration foraccurate results, while the WindowsXP based software system automat-ically reduces archived data. TheRealTime HIV-1 assay measureslevels of the HI-Virus and could beused as marker of disease prognosisand for validation of antiretroviraltreatment.

Abbott Diagnostics also pre-viewed twelve new analyzers,including five systems of theARCHITECT pipeline. The units,which are all expected to enter themarket by early 2009, offer clinicallaboratories with low- to high-vol-umes great flexibility.

Beckman Coulter’s UniCel fa-mily of multi-platform systems is designed to be cross-functio-

nal, accommodating chemistry,immunoassay, haematology andeven future components. Processingup to 200 tests per hour, the newUniCel DxI 600 is designed as theideal full-featured solution for themid-volume testing range. The DxI600 is easy to use and offers morethan just robust features: On-boardalliquotting and refrigerated sam-ple-storage, allowing immediateexecution of reflex tests or reruns. Ithelps laboratories to reduce costs.

Siemens Medical SolutionsDiagnostics announced the ADVIA1800 chemistry analyzer. ADVIAseries’ key features, a faster andmore reliable ISE test module, andeasy sample and reagent loadingprovide a productivity benefit. Theunit could be connected to theADVIA WorkCell or ADVIALabCell Network Solutions withoutneed to acquire expensive interfacehardware. With a performance ofup to 1800 tests per hour, or 200Basic Metabolic panels per hour, thenew system ensures that peak work-loads could be handled quickly.

Tony Bihl, CEO of SiemensMedical Solutions Diagnostics,explains that his company com-

21st in Munich in 2008

make active ingredients less effective.Biochips identify the types of resistan-ces by analyzing the virus’ genome.Medications that would be ineffectiveare not even considered.

Roche also has a gene chip that makesit easier to choose the optimum medica-tion in the right dose. Its AmpliChip CYP450 is now licensed for diagnostic pur-poses in the USA and Europe.

Genetic diagnostics is still reserved for specialised laboratories. However, asanalytica promises to show, chiptechnology is becoming more userfriendly. Detection kits with ready-to-usereagents, all-in-one concepts consistingof micro-arrays, hybridisation stations,scanners and analysis software as wellas ongoing advancements in automationare making it easier for chip technologyto be incorporated into routine clinicalapplications. Costs must also be consid-ered, and there are already attractivealternatives to common fluorescencescanners; these detect hybridisationelectrochemically or by precipitating sil-ver onto gold nanoparticles

Identifying minor genetic defectsThe fact that patients react differently toa given therapy despite a 99.9% geneticmatch is frequently due to single-nucleotide polymorphisms (SNPs, pro-nounced snips). A SNP is a minor defectin the script of the genetic mapping.Only a single letter, i.e. a base, is inter-

changed. Experts assume that there areten million SNPs in the human genome.In many cases, SNPs are the cause ofdiseases.

The NGFN (Germany’s NationalGenome Research Network), a group ofresearchers working in various fields,wants to use DNA chips to examine25,000 patients and control people.Scientists want to identify the geneticcauses of obesity, Alzheimer’s, neuro-dermatitis, schizophrenia, tuberculosisand many other diseases.

Peter Nürnberg, Professor ofGenomics at Cologne University andcoordinator of the genotyping platform at the NGFN, and his colleagues, willcollect over 20,000 individual samples.There are more than a half-million SNPsand other gene variations on the chipsthey use.

Such large-scale projects are onlypossible using state-of-the-art bio-analysis, molecular-biology and infor-mation-technology tools, and the latestof these – e.g. micro-array scannerswith integrated barcode readers, andexpanded bioinformatics software foranalyzing and storing enormous quanti-ties of data – will be at the Munichevent.

Cost cutting

Protein chips are increasingly used toascertain which genetic products, i.e.which proteins, actually affect a cell.Decoding proteins gives pharmacyresearchers a point of departure fornew active ingredients. Biomarkertests, which filter out unsuitableactive-ingredient candidates beforethey are tested on patients, also helpcompanies to cut costs considerably.Pharmaceutical companies also profitfrom the trend towards personalisedmedicine in another way: some block-buster medications would still be onthe market today if the patients whotend to have bad reactions for geneticreasons had been filtered out andtreated using other alternatives.Automation – Laboratory robotics, ITand efficient new analysis techniquesare giving rise to large contract labora-tories that can process customers’orders quickly and flexibly, the analyti-ca organisers emphasise. ‘An examplein the biotechnology sector is PCRanalysis: the latest techniques havemade it possible for laboratories towork twice as quickly, resulting in amultitude of applications in infectiondiagnostics and food analysis.’ The Innovations Area – Alongside

leading manufacturers, research institutesand small innovative companies are push-ing progress, so analytica has created a sec-tion for start-up companies, university spin-offs, founder centres and research institutesto present their ideas to industry and abroad-based audience of specialists. Theycan book space to present their concepts,and utilise a Technology and InnovationsForum to further discuss innovations.New: Education courses – For the firsttime analytica will hold education and train-ing events for laboratory workers, as well asan Executive Roundtable where managerscan discuss trends and topics in an auditori-um with an audience of professionals.

The analytica Conference has long been asummit for cutting-edge research, andagain there will be Job Day, and the analyt-ica Forum – for 2008, renamed the Business& Markets Forum – which will feature pre-sentations and panel discussions on eco-nomic-policy and business topics.

In 2008, about 30,000 visitors are expect-ed – about a third of these from countriesbeyond Germany.Details: www.analytica.de

data are loaded manually and avirtual file created automatically,based on the users preferences,the automatic dotSlide SL has aslide loader holding up to 50 slidesin 5 trays. A robotic arm places theslides on to the stage holder andthe integrated barcode scannerensures any bar-coded meta-dataare automatically loaded andlinked with the resultant virtualimage, Olympus reports.In researchThe fluorescence compatibledotSlide can be used for tissuemicro-arrays (TMAs) via thedotSlide TMA model. This facili-tates the acquisition and simpleanalysis of tissue micro-arrays.TMAs consist of many small tissuecores with defined diameter thatare fixed on a single slide. Themodel documents each core sepa-rately, accurately recording itsslide and core reference for trace-ability.

For technologyThe dotSlide workstation and serversystem enable fully controllableremote access. Data and associatedmeta-data are saved in a bespokedata management system meaningthat slides can be scanned in onelocation and reviewed almostinstantaneously in another, any-where in the world, by users eithervia a web browser.

Using the specialised OlyVia, soft-ware pathologists can review andcomment on the virtual slide andare able to add annotations, mark-ers and files (including dictations) tobe directly linked to the slide. Thissoftware has many other assets anddeserves to be followed up.

A Peltier cooled, 1376 x 1032pixel dotSlide camera also offershigh resolution, fast frame rates andvery high sensitivity with an excel-lent signal-to-noise ratio, broaddynamic range and superior imagequality.

bined in-vitro and in-vivo capabilityby cementing it with IT. ‘When theformer Bayer Diagnostics acquiredImulite, it merged immuno assaycapability to Bayer’s chemistry. Thatenabled Bayer to serve more and alsosmaller hospitals and to process99% of all tests coming from highlyautomated laboratory lines. SinceJanuary 2007, as part of SiemensMedical Solutions, Siemens providesthe IT which manages the immensedata, builds and incorporates therules and thereby shows not onlyaccurate data results, but prescribestherapies that are sped off to thetreating physician. The result is

expedited workflow and efficiencyin the lab and hospital and fasterimproved outcomes for patients.’

Roche’s subtle innovations sup-port bi-directional network integra-tion to the cobas IT1000 Point ofCare Data Management Solution.Automated result entry and qualitycontrol greatly enhance Patient safe-ty. The cobas b221 is Roche’s newmulti-parameter analyser for bloodgas, electrolytes, CO-oximetry andmetabolites. Long-life sensors andan automated QC-System reducemaintenance to a minimum. TheCoaguCheck SX system currentlyreceived FDA approval. It measuresPT/INR quickly, stores 500 testresults and has QC lock-out capabil-ities.

The Accu-Check Inform embodiesPoint of Care Testing abilities. It’s ahand-held system aimed for glucosetesting in hospitals. Test Strips allowsampling from capillary, venous orarterial blood. The user-friendly sys-tem features enhanced electronicdocumentation: Internal memorystores up to 4,000 patient-specificmeasurements, while a user com-ments section is fully customisable.

Scientists presented studies anddiscussed clinical topics, showingthat innovations really have featuresthat could be used to improve thesituation of patients.

The American College ofObstetricians and Gynaecologists(ACOG) suggested chromosomalscreening to all pregnant women,regardless of age, as improved non-invasive methods allow earlier test-ing at low-risk. ‘Amniocentesis isstill the gold standard, but it’s aninvasive procedure that carries a fargreater degree of risk for the preg-nancy than a non-invasive screeningtest,’ said Jacob Canick, PhD,Women and Infant’s Hospital in

Providence, RI. First trimester ultra-sound and biochemcial testing, more-over integrated screening in first andsecond trimesters, achieve detectionlevels of nearly 90%.

An expert panel assembled by the Health Resources and ServicesAdministration and the AmericanCollege of Medical genetics released anation-wide newborn screening stan-dard, which was long overdue. Theuniform condition panel for newborndisorder screening already showsgreat effect. ‘Testing is now being per-formed far more homogeneous than inthe past and we are close to a fullimplementation across the country,’said Piero Rinaldo, MD, PhD, expertpanel member and the T. DennySanford Professor of Paediatrics at theMayo Clinic in Rochester, MN. Theuniform panel includes 54 conditions,thereof 42, that can be detected usingtandem mass spectrometry. ‘Next weneed to start talking about perfor-mance metrics – setting targets andmeeting them.’

One-third of Americans are consid-ered to be obese. Research findingsfrom the University of Colorado’sCentre for Human Nutrition show,that adipose tissue has to be consid-ered as a separate body organ. It pro-duces inflammatory cytokines andfatty acids – biologically active mod-ules that lead to development ofhypertension, coronary heart disease,stroke, type 2 diabetes or other ill-nesses. Marc-Andre Cornier, MD,explained that traditional monitoringof plasma glucose, HDL and LDL,triglycerides and HbA1C is stillimportant. Genetic tests could providea more complete picture in the future,but are not available yet.

AACC is expecting to grow evenbigger between now and its nextevent, to be held in Washington, DCfrom 27–31 July 2008.

analytica comes of age


S U R G E R Y

PAEDIATRIC SURGERY: A MAJOR CHALLENGE

UK – A report on the care of young surgi-cal patients has been launched by TheChildren’s Surgical Forum, a body of rep-resentatives from the medical royal col-leges, surgical specialist associations,Department of Health, Royal College of

Nursing and the Royal College ofSurgeons Patient Liaison Group.

Titled ‘Surgery for Children: De-livering A First Class Service’, it re-commends improvements in each sur-gical specialty, and provides a defini-tive guide on standards for thoseresponsible for young patients, withinformation on safe models of careand service development. Recom-mendations range over the local andcentralised (specialist) organisation ofchildren’s surgical services, as well aspaediatric training, appropriate work-force planning, and considerablymore essential information for paedi-

atric units or children’s hospitals.David Jones FRCS, Royal College of

Surgeons Council member and Chair ofThe Children’s Surgical Forum, saidthat in the seven years since theForum’s first report, surgery for chil-dren has ‘changed beyond recogni-tion’. However, he pointed out that,although techniques have improvedand more can be done for children,fewer hospitals can provide those ser-vices. ‘We have reached a point wherethere are now major challenges facingsurgical care for children.’ Whilst rou-tine surgery should be available locally,to achieve best outcomes, specialist

services need to be centralised, DavidJones added. Although there are excel-lent clinical networks in children’ssurgery, further developments of suchnetworks are needed. ‘However,’ hepointed out: ‘Current health policyreforms that introduce competition canprovide a disincentive for Trusts to col-laborate in the interests of the patient.’The report recommends that children’ssurgical services be protected fromcompetition and commissioned sepa-rately. ‘The report contains importantmessages for clinicians, support staff,service planners, commissioners andpolicy makers,’ he said. ‘We hope that

Flexibleendoscopy Achieving precise power output andproven argon plasma coagulation

Internal medicine specialistMartin Raithel is AssistantMedical Director of MedicalClinic 1, at Friedrich AlexanderUniversity, Erlangen-Nuremberg,and heads the Endoscopydepartment; the Functional TissueDiagnosis Laboratory, and theclinic for chronic inflammableand allergic intestinal diseases.

Many publications have already appearedrelating to the outstanding characteristicsof ARC generators in conjunction with theARC Plus, Bowa points out. ‘Like its bigbrothers in the ARC series, in conjunctionwith the ARC Plus, the Bowa ARC 200makes an unbeatable system. An unbe-lievably low 10 Watt power settingenables argon plasma coagulation to becarried out safely and with particularlyfine dosing. The penetration of argonplasma coagulation can therefore bealmost steplessly controlled. In this way,efficient coagulation can be producedeven more safely in areas that are sensi-tive to perforation, such as the smallintestine, for example. Stuck electrodesand mechanical traumas are avoidedthanks to the non-contact process.’

In gastroenterology the process isparticularly suitable for polypectomy,papillotomy, double-balloon enteroscopy,coloscopy, mucosectomy, rectoscopy andgastroscopy (Bowa provides the variousflexible probes).

‘To guarantee reliable argon ignition,the ARC Plus argon coagulation unit and the ARC generators are optimallymatched to one another. The wide argongas control range of 0.1 l to 9.5 l/minallows the system to be ideally adapted tothe type of operation,’ Bowa adds. ‘Argonplasma coagulation can be used withrigid or flexible probes. Power settingsfrom 1 Watt to 120 Watt are possible.’

The Argon-Flex, GastroCut Pap andGastroCut Pol programmes are providedfor flexible endoscopy, and the unit has anargon programme for open or laparoscop-ic surgery.

‘The combination of cutting and coagu-lation current achieves optimum resultswhen using polypectomy loops or papillo-tomes,’ Bowa points out. In addition, thehaemostasis effect of the cutting currentcan be finely controlled at the press of abutton.* ‘Applicability, effectiveness and safety of Bowagenerators and argon units in gastroenterologicalendoscopy’, by M Raithel; J Hänsler and EG Hahn ofUniversity Clinic Erlangen, and A Nägel of Bowa-electronic, published in Endoscopy today 3/06.

our recommendations are implement-ed in each hospital with the help oflead clinicians for children’s surgicalservices.’

Dr Jane Collins, CEO of GreatOrmond Street Hospital, where thereport was launched, commented: ‘It isimportant that commissioners as wellas CEOs of hospitals look at thereport’s recommendations.’

This report is timely: NHS healthcaredelivery is currently under review. Oneimportant statistic: Although the esti-mated number of consultant paediatricsurgeons needed in England is 256 by2010, currently there are only 104.

Professor Martin Raithel MD* worksalongside medical devicesmanufacturer Bowa on the use ofargon plasma coagulation inendoscopy. ‘The argon unit, inconjunction with the generators of theBowa ARC range, is working veryreliably in different disciplines,’ hesays. ‘It is opening up new methods inflexible endoscopy with argon-assistedelectrosurgery due to its outstandingignition and power characteristics.’


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E 8/

2007

Главные темы конгресса стволовыеклеткиТерапевтические возмо жности взрослых стволовых клеток в лечении сердечно-сосудистых заболеваний.

Штефан П. Янссенс, док-тор медицины, доктор наук,работающий в отделениикардиологии университетско-го госпиталя Гастхюисберг,(Католический университет г.Лейвен, Бельгия), рассмат-ривает пересадку стволовыхклеток для лечения пораже-ний сердца как многообеща-

Абсорбируе-мые металли-ческие стенты– за и против.

Коронарные стенты уку-тывают стенки сосуда, темсамым обеспечивая их за-щиту от диссекции, и умень-шают вероятность рестено-за после проведенной под-кожной транслуминальнойкоронарной ангиопластики.В дополнение к этому, стен-ты транспортируют в орга-низм лекарственные сред-ства. Так, заряженные анти-пролиферативными веще-ствами, они препятствуютинтимальной гиперплазиии, таким образом, еще вбольшей мере противодей-ствуют возникновению рес-теноза.

Дирк Бёзе, доктор меди-цины ЗападногерманскогоКардиологического Центра,(отделение кардиологии,Университет Дуйсбург-Эс-сен), утверждает, однако,что стенты являются ино-родными телами, которыепревращают эластичныесосуды в ригидные трубки,причиняют вред вазомото-рике, что их применениевызывает необходимость вдолговременной противо-тромбозной терапии из-засуществующего риска воз-никновения тромбов впос-ледствии.

С целью преодоленияограничений современнойтехнологии стентированиябыл разработан абсорбиру-емый металлический стентиз сплава на основе магния(AMS). Эффективность аб-сорбируемых металличес-ких стентов при лечении ко-ронарных артериальныхстенозов была определенав результате клиническихиспытаний PROGRESS-AMS. Эти исследованияподтвердили концепцию,согласно которой самораз-лагающиеся биологическимпутем магниевые стентымогут быть столь же эффе-ктивны в плане достижениялечебного результата, как идругие металлические стен-ты, но в течение 4 месяцевполностью самоуничтожа-ются, не причиняя вредаорганизму.

(См. страницы: 8)

Др. Дирк Бёзе

Инфаркт миокарда характе-ризуется ишемией и утерейтканей сокращающихся мышцсердца. Последствием явля-ется сердечно-сосудистая не-достаточность. Лечение припомощи аутологичных стволо-вых клеток, взятых из тканикостного мозга, входит в прак-тику и имеет целью восстано-вить сердечную мышцу припомощи инъекций в нее ство-ловых клеток.

Методика трансплантации врайон, пораженнный инфарк-

ющий путь развития в кардио-васкулярной медицине. Ран-домизированные, плацебо-контролирумые, с двойнойстепенью анонимности прове-денные исследования резуль-татов пересадки автологич-ных стволовых клеток костно-го мозга пациентам с инфарк-том миокарда дали показате-ли улучшения степени восста-новления общей функции ле-вого желудочка от 1,2% до2,5% . Данный результат со-провождается благоприятнымэффектом на перфузию мио-карда, а также ремоделирова-нием инфаркта с значитель-ным его уменьшением и улуч-шением восстановления реги-онарной функции левого же-лудочка.

том, был разработан в Дюс-сельдорфе профессоромШртауэром. После реканали-зации пораженного инфарк-том сосуда методом баллон-ной диллятации в него поднизким давлением вводятсястволовые клетки.

Последующий контроль по-казывает долговременноеулучшение сердечной функ-ции в среднем в 50% случаеви уменьшение размеров ин-фаркта примерно в 20% слу-чаев. Снабжение сердечной

мышцы кровью значительноулучшается, улучшается так-же метаболизм, увеличива-ются физические силы. Результаты были подтвер-ждены по всему миру, до на-стоящего времени не посту-пало сообщений о побочныхэффектах.

Аналогичная процедуратакже эффективна при забо-левании периферическихартериальных сосудов.


Если прогресс общего вос-становления функций можетпоказаться скромным, тем неменее он представляет со-бой улучшение результатовпочти такого же уровня, как иначальные терапевтическиерезультаты от первичной ко-ронарной реваскуляризации.

Убедительные данные, по-лученные в результате иск-лючительно обширных, ран-домизированных, с двойнойстепенью анонимности ис-следований показали, чтопациенты , страдающие зна-чительным снижением функ-ции миокарда, получаютпользу от приостановленнойв настоящее время страте-гии пересадки клеток.


Штефан П. Яннссенс, др.мед,др.фил.

Трансплантация стволовыхклеток помогает восстановитьсердце

Московскаямедицинская выставка-яр-марка

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ИТ & Телемедицина

Российская ассоциация те-лемедицины и Департаментздравоохранения ОАО«РЖД» организуют обучениев IX Международной школепо теме «Современные аспе-кты телемедицины». Занятиябудут проводиться c 16 по 26октября 2007 в Москве (руко-водитель школы Л.В. Столяр)

В течение 10 дней для слу-шателей школы из РФ истран СНГ будет предложен72-часовой курс теоретичес-ких и практических занятийпо телемедицине и совре-менным медицинским ин-формационным технологи-ям. Лекторы - ведущие рос-сийские и зарубежные спе-циалисты. Обучение рассчи-тано на организаторов рабо-ты телемедицинских центров(врачей) и технический пер-сонал, обеспечивающий ра-ботоспособность оборудова-ния и каналов связи телеме-дицинского центра.

Обучение проводится нарусском языке. Лекции зару-бежных специалистов будутсопровождаться синхроннымпереводом. В ходе школыпланируется проведение се-рии круглых столов по проб-лемам использования теле-медицинских технологий имедицинских информацион-ных систем, демонстрацияновых технологий и оборудо-вания.

Часть лекций проводитсяна базе видеоконференцсвя-зи. По этой же технологии бу-дет заслушан ряд сообще-ний российских и зарубеж-ных телемедицинских цент-ров об опыте использованиятелемедицинских техноло-гий.В ходе обучения слуша-тели школы с помощью кон-сультантов должны будутподготовить и защитить ре-альные проекты телемеди-цинских центров, предусмат-

Частная онкологическаяклиника SanaFontis воФрайбурге основана в ап-реле 2006 года и распола-гает 85 койками разныхкатегорий и возможностьюразмещения сопровожда-ющих лиц.

Клиника SanaFontisпредставляет собой меж-дународный центр совре-менной терапии рака и на-учных клинических иссле-дований, базирующихсяна компетенции и профес-сионализме. „Мы исполь-зуем не только актуаль-ные методы терапии рака,но и открыты для иннова-ционных подходов к лече-нию и применению допол-нительных методов. Наря-ду с самыми современны-ми программами леченияи новейшим диагностичес-ким оборудованием, при-

пользования тестов на чув-ствительность к химиотера-пии и основательно прово-дим медицинское обследо-вание, - например при по-мощи диагностического то-мографа ПЭТ/КТ.

В зависимости от индиви-дуальных показаний мы на-значаем химиотерапию,гормонотерапию или облу-чение. При прогрессирова-нии раковых заболеваниймы используем по желаниюпациентов новые методытерапии - такие как анти ан-гиогенез (блокированиеопухолевых сосудов) илииммунотерапию.

Часто проходят десятиле-тия, прежде чем новые ме-дикаменты получают дос-туп в практическую меди-цину. К сожалению, пациен-ты, страдающие раком, немогут так долго ждать. Поэ-

тому мы, в рамках клини-ческих исследований, пре-доставляем в распоряже-ние наших пациентов ин-новационные медикамен-ты.

Специальная программапитания с использованиемнутриентных микрокомпо-нентов предотвращаетистощение организма; тра-диционная китайская ме-дицина укрепляет сопро-тивляемость и снижаетболи; физиотерапия воз-вращает силу и выносли-вость; психоонкологичес-кая поддержка помогаетвернуть жизнерадостость.

КонтактTumorklinik SanaFontis, An den Heilquellen 2, 79111 FreiburgMail: [email protected]

оритетом для нас являетсязаботливое обхождение снашими пациентами, под-черкивает медицинский ди-ректор клиники, профессордоктор Йоахим Древс.

Наша главная задача -лечение пациентов с боль-шими опухолями, лимфо-мами и определенными ви-дами лейкоза на базе обширной и целостной про-граммы. При этом в центревнимания стоит не заболе-вание, как изолированноесобытие, а человек.

Международная группаврачей предлагает лечениепациентам из разных угол-ков мира, в том числе ирусскоязычным пациентам.

Мы работаем с перспек-тивными технологиями - отсовременной лаборатор-ной медицины для опреде-ления биомаркеров, до ис-

Позвольте представиться - SanaFontis

МЕЖДУНАРОДНАЯ ШКОЛА ТЕЛЕМЕДИЦИНЫ В РОССИИ

ривающие полноценное взаи-модействие с информацион-ными системами клиник.

Основные направления ра-боты школы состоят в изуче-нии:� современных средств те-

лекоммуникации, примени-тельно к задачам телеме-дицины;

� современные системы ви-деоконференцсвязи (ста-ционарные и мобильные);

� методы и средства обеспе-чения конфиденциально-сти видеоконсультаций;

� стандарты медицинскойинформатики и телемеди-цина;

� медицинское оборудова-ние телемедицинских цент-ров;

� экономика телемедицины;и ряд других направлений

тем не менее важных и инте-ресных

Научными консультантамишколы являются:

Президент российской ас-социации телемедицины, ви-це-президент ОАО «РЖД»,профессор Атьков О.Ю. (Рос-сия)

Президент итальянской ас-социации телемедицины про-фессор Ф.Сикурелло (Ита-лия)

Президент международнойассоциации телемедицины,профессор регенсбургскогоуниверситета М. Нерлих (Гер-мания)

Президент ассоциации при-кладных технологических се-тей, профессор М.Чермак(Швейцария)

Контакт:Наш адрес и телефон:Рублевское шоссе д. 135121552 г. МоскваРоссиятел./факс: 007495 414-79-34E-mail:[email protected]

Кевин И. Хоберт, CEO of CarestreamHealth Inc

Недавно, в результатеприобретения корпораци-ей «Onex» группы«Health», принадлежавшейранее фирме «Kodak», на-чала свою деятельностьфирма «CarestreamHealth Inc.» в качестве од-ной из ведущих в мире не-зависимых компаний пополучению медицинскойграфической информаци-ии и разработки информа-ционных систем.

Кевин Дж. Хоберт, Гене-ральный директор фирмы«Carestream Health Inc.»,разъясняет: « Наш пере-

ход в разряд независимыхкомпаний не меняет прин-ципов нашего подхода кобслуживанию клиентов.Благодаря этому, мы по-лучили в настоящее вре-мя невероятно хорошиевозможности инвестиро-вать в будущее, основы-ваясь при этом на всейнашей предыдущей рабо-те по внедрению иннова-ций. Мы хотим перевестинаших клиентов от бумагии пленки к полностью ди-гитальному процессу ра-боты, и благодаря этомупереходу, помочь имулучшить качество иуменьшить затраты».

Кевин Хоберт подчерк-нул также: «Наши дости-жения в получении изоб-ражений на молекуляр-ном уровне очень сущест-венны, мы можем предос-тавить не только фото-пленки и фотохимикаты,но также дигитальныеграфические системы иконтрастные средства, не-обходимые для получе-ния графической инфор-мации. Мы настроены бо-лее чем оптимистично вотношении наших буду-щих возможностей», до-бавил в заключение Хо-берт.


ИТ - РешенияВхождение в корпорацию «Onex» обещает придать большую гибкость фирме, занимающейся получением медицинской графической информации, а также информационными решениями


Новости / Кардиология

Количество злокачествен-ных заболеваний печени, же-лудка, поджелудочной железыи кишечника в последнее вре-мя постоянно растёт. Данноеобстоятельство требует про-ведения быстрой, высокоспе-циализированной и комплекс-ной терапии в клиниках.

Университетская клиникаГамбург-Эппендорф одна изкрупнейших и одна из лучшихклиник в Германии и в Европе.Центры клиники по лечениювышеуказанных болезней воз-главляются директорами, ко-торые известны во всём миреблагодаря своим блестящимработам.

Профессор Нашан являетсяодним из ведущих специали-стов в мире по лечению всехзаболеваний печени. Воспа-ления и раковые заболеванияпечени, желчного пузыря ипротоков часто требуют хи-рургического вмешательства,а иногда и трансплантации пе-чени. Центр трансплантацииуниверситетской клиники раз-

работал специальную техникупроведения операций, в ходекоторых осуществляется пе-ресадка органов (почек) илиих частей (печени). В боль-шинстве случаев донорамиявляются родственники боль-ных, что не вызывает отторже-ния пересаженных органов.Пациенты, получившие такимобразом органы могут вестинормальную жизнь.

Профессор Избики извест-ный во всём мире специалистпо лечению заболеваний же-лудка, кишечника и поджелу-дочной железы. Необходимыеоперации, вызванные раковы-ми заболеваниями, должныпроводиться такими специа-листами как профессор Изби-ки. Междисциплинарное кли-ническое сотрудничество раз-личных Центров клиники Гам-бург-Эппендорф, как напри-мер Онкологической клиники(хемотерапия) и Радиоонколо-гии (лучевая терапия) позво-ляет вести систематическуюборьбу с болезнями и знчи-

тельно повывышает шансы навыздоровление

Клиника Гамбург-Эппен-дорф обладает наибольшимопытом в лечении пациентовиз других стран. Международ-ный оффис клиники решаетвсе организационные вопросыс иностранными пациентамина их родном языке. Сюдавходит широкий круг вопросовпо въезду в Германию, финан-совые вопросы, определениестоимости медицинского об-служивания, согласованиесроков, подготовка медицин-ских заключений и оформле-ние МРТ/КТ - рентгенологиче-ских обследований в клиникена русском языке.

В Международный оффисКлиники можно позвонить 24часа в сутки каждый день потелефону:+ 49 40 42803 7294, E-Mail: [email protected]или отправить факс по номе-ру: +49 40 42803 1691.

Специалисты по лечению печени, желудка,кишечника и поджелудочной железыЛечение в Университетской клинике Гамбург-Эппендорф (UKE), Германия

Молекулярная медицина в качествеоружия против склеротических бляшек высокого риска

Часто не размер бляшкив коронарном сосуде, ностепень ее стабильностиопределяет, насколько вы-сок риск возникновенияинфаркта миокарда. Ини-циатива «Склеротическиебляшки высокой степенириска» (High-Risk PlaqueInitiative), основанная сов-местно фирмами «PhilipsMedizin Systeme», «Astra-Zeneca», «Merck & Co»,«BG Medicine» и «Huma-na» фокусируют свои уси-лия на возможностях, ко-торые открывает молеку-лярная медицина. Иссле-дователи пытаются найти

подходящие биомаркеры,которые позволили бы ранодиагностицировать и про-водить целевую терапиювоспаленных, так называе-мых опасных бляшек.

Неожиданный разрыв та-кой нестабильной воспа-ленной бляшки происходитбез первичных симптомов в70-75 процентов случаевинфарктов миокарда.

Поль Смит, ответствен-ный за вопросы стратегии иразвития фирмы «PhilipsMedizin Systeme», объясня-ет: «Потребуется примерночетыре года, прежде чеммы сможем идентифициро-

Диагностика артеросклероза и визуализация склеротических бляшек:

Магнитно-резонансная то-мография обеспечиваеточень широкие диагностиче-ские возможности для карди-ологии.

Профессор Бернд Хамм,Институт радиологии клиникиШаритэ, Берлин, разъясняетвозможности этой методикиполучения изображений:

«Магнитно-резонансная то-мографическая технологияновейшего уровня обеспечи-вает ангиографию всех сосу-дов организма и открываетвозможности для визуализа-ции всех сосудов человечес-кого тела неинвазивным ме-тодом. Мы проводим фунда-ментальные исследования в

области получения медицин-ской графической информа-ции на молекулярном уровнес целью визуализации и диф-ференциации стабильных инестабильных атеросклероти-ческих бляшек. Рабочая груп-па по нанотехнологиям, соз-данная для сотрудничества висследованиях между «Шари-тэ» и фирмой «Сименс», ра-ботает с мельчайшими метал-лическими частичками. Этичастички могут сделать неста-бильную бляшку видимой намагнитно-резонансном томо-графе. Мы можем обеспечитьанализ степени риска с оченьвысокой точностью.

Мы осуществляем также ва-

жные исследовательскиепроекты, связанные с компь-ютерной томографией - мыработаем с 64-срезным ком-пьютерным томографом,способным очень надежновизуализировать коронар-ные сосуды. Мы предполага-ем достичь огромного про-гресса в медицинской компь-ютерной графике в областикардиологии уже в ближай-шем будущем, и это позво-лит нам обеспечить болеераннюю и точную диагности-ку заболеваний.»


вать опасные бляшки припомощи биомаркеров.Ранняя диагностика моглабы способствовать сокра-щению последующих за-трат и открыть новые воз-можности терапии во бла-го пациентов.»


Пауль Смит, Philips Medizin Systeme

EUROPEAN HOSPITAL

READER SURVEY –имеется возможность интересного выигрыша!

Хотели бы Вы выиграть великолепный корот-кий отпуск, включющий так называемуюFit4Work-диагностику менеджера и VIP-билетыдля посещения футбольного матча Лиги чем-пионов УЕФА с участием футбольного клубаFC Schalke 04 в г. Гельзенкирхене, Германия?

При содействии клиники medicos.AufSchalke, которая явля-ется официальным партнёром футбольного клуба FC Schalke04 в области физической подготовки и контроля за состояниемздоровья игроков, мы проводим розыгрыш первокласного отпу-ска для 2 человек: Вы проведёте две ночи в 4-х звёздочномотеле Courtyard by Marriot, окруженные всем необходимым.Днем Вы можете насладиться Fit4Work-Premium диагностикойв клинике medicos. Auf Schalke – междисциплинарном центрекомпетенции здоровья. Вечером Вам предстоит увидеть инте-реснейший футбольный матч Лиги чемпионов УЕФА из VIP-ло-жи клиники medicos на стадионе Veltins Arena.

Условия участия в розыгрыше:Условия участия в розыгрыше: если Вы заполните прилага-емый формуляр и привлечёте в качестве читателя нашейгазеты одного из Вашиз коллег, выполняющего врачебнуюили организаторскую функцию в Вашей клинике, тогда Выявляетесь участником розыгрыша.последний срок отправки 31 октября 2007 г.Члены редакции газеты EUROPEAN HOSPITAL участия в розыгрыше приза не принимают. Правовые претензии не принимаются.

Пожалуйста заполните купон и отправьте его в наш адрес:по факсу: +49 201 87126 864по почте: EUROPEAN HOSPITAL Verlags GmbH,Theodor-Althoff-Str. 3945133 Essen, Germanye-mail to:[email protected]

Пожалуйста укажите Ваше имя и адресКлиника/фирма:

Фамилия:

Должность:

Улица:

Почтовый индекс: Город: Страна:

Номер телефона: Номер факса:

e-mail:

Пожалуйста укажите имя и адрес Вашего коллеги, ко-торый хотел бы получать газету EUROPEAN HOSPITALКлиника/фирма:

Фамилия:

Должность:

Улица:

Почтовый индекс: Город: Страна:

Номер телефона: Номер факса:

e-mail:

ПрофессорБернд Хамм

Магнитно-резонансная томография откры-вает новые перспективы в кардиологии


Новости / Дыхание

Fit4Workmedicos.AufSchalke

medicos.AufSchalke

www.medicos-AufSchalke.de

Новейший пакет для успеха Вашего предприятия

может проводить регулярный контроль состо-яния здоровья сотрудников Вашего предприятия: Fit4Work! Рядомсо стадионом футбольного клуба FC Schalke 04 группы врачей различных специализаций, терапевты и учёные, областью иссле-дований которых является спортивная медицина, позаботятся оздоровье ведущих менеджеров и рядовых сотрудников Вашегопредприятия. Мы охотно информируем Вас об этом.

официальный партнёр футбольного

клуба FC Schalke 04 по контролю за

состоянием здоровья и спортивной

формой игроков клуба.

Тел.: 0049 (0) 209-380330

�озвольтепредствиться —

SanaFontis!

�еждународная онкологическаяклиника у подножия �варцвальда

�ндивидуальный подход к лечениюопухолей, включая возможность участия в клинических исследованиях

�овременная диагностика с �Э#/$#

#ерапия рака по современныммировым стандартам, в том числедополнительные методы, какнапример, нутриентныемикрокомпоненты, #радиционнаякитайская медицина и терапия болей

&усскоговорящие врачи и медсестры

�осетите наш стeнд номер B 30 на«�осковском �едицинском салоне», мы охотно проконсультируем )ас.

International Cancer Hospital on theedge of the Black Forest

Personalised anti-tumour therapiesincluding clinical trials

Leading in-house diagnostics inlcudingPET/CT scanner

Complementary therapies e.g. micro-nutrients, Traditional Chinese Medicine,pain therapy

Multilingual medical and nursing staff

Visit us at the booth at the MoscowMedical Fair, B30.

Cancer Hospital SanaFontisAn den Heilquellen 279111 Freiburg, GermanyE-Mail: [email protected]

Университетский медицин-ский комплекс ШАРИТЕ – этов целом 3500 койкомест и15.000 сотрудников в 80 спе-циализированных клиниках,каждая из которых являетсявысококвалифированной еди-ницей. Будучи учебной и науч-ной базой знаменитых Бер-линских университетов имениГумбольдта и СвободногоУниверситета мы, образно го-воря, концент-рируем диаг-ностику и лечение, научныеисследования и обучение пододной крышей.

Медицинская исследова-тельская работа и использо-вание ее результатов являют-ся душой университетскогомедицинского комлекса ША-РИТЕ. Около 55 научно-ис-следовательских институтов,относящихся к ШАРИТЕ, в томчисле такие знаменитые учре-ждения как Институт инфекци-онной биологии им. МаксаПланка, Институт им. РобертаКоха и Институты микробио-логии и вирусологии ШАРИТЕобеспечивают нашим пациен-там и впредь медицинскоеобслуживание высочайшегокласса.

Ни в одной другой клиникеЕвропы нет такого средоточияизвестных врачей, специали-стов и корифеев, как в Уни-верситетском медицинскомкомплексе ШАРИТЕ. Соответ-ственно превосходным явля-ется и оснащение медицин-ской техникой. Взаимодейст-вие между различными специ-альностями, комплексная ме-дицина, коллегиальность и,конечно же, высочайшая ква-лификация всего врачебно-профессорского состава обес-печивают медицинское обслу-живание высшего качества.

Главное в ШАРИТЕ – этоздоровье и хорошее самочув-ствие наших пациентов. Лич-ные консультации и доступнаядля понимания информацияважны для нас так же, как ииндивидуальное обслужива-ние пациентов. При этом меж-дународный коллектив врачейи медсестер учитывает, разу-меется, культурные традициии религиозную направлен-ность иностранных пациен-тов.

Для организационной под-держки Вашего стационарноголечения в ШАРИТЕ обращай-тесь, по-жалуйста, в наш оф-фис „Charité International“. Со-трудники этого центра кон-сультации и оформления ино-странных пациентов позабо-тятся о Ваших медицинскихпроблемах, а также обо всехюридических и администра-тивных формальностях - разу-меется при соблюдении стро-жайшей конфиденциальности.

Для оценки возможности ле-чения в ШАРИТЕ нам нужна

как можно более подробная и– что очень важно – самая по-следняя мединская информа-ция о Вас (выписка из историиболезни). Эту информациюВы можете прислать нам пофаксу, электронной или обыч-ной почтой. Исходя из полу-ченных документов, мы сразуже сообщим Вам наши пред-ставления о целесообразно-сти дальнейших мер.

При необходимости стацио-нарного лечения Charité Inter-national вышлет Вам в самыйвозможно короткий срок инди-видуальное предложение. Внем содержится сообщение орасходах на лечение и уход, атакже о максимальном време-ни пребывания в нашей кли-нике.

Гостиница Вирхов-Гестехауснаходится непосредственнона территории клиники им. Ру-дольфа Вирхова университет-ского медицинского комплексаШАРИТЕ. В 22-х современныхномерах гостиницы с предос-тавлением завтрака могутразместиться наши пациентыи сопровождающие их лица.Конечно же, мы охотно помо-жем Вам в поиске другой гос-тиницы на Ваш вкус. Контакт:Charité InternationalAugustenburger Platz 113353 Berlin – Germanywww.charite.de/international/Email:[email protected]: +49 30 / 450 570 000Fax: +49 30 / 450 570 977

Шарите - Крупнейшая университетская клиника ЕвропыУниверситетский медицинский комплекс г. Берлин

же туберкулезом с расши-ренной лекарственной ус-тойчивостью к противоту-беркулезным препаратам.

С января 2006 года началосуществляться новый гло-бальный план антитубер-кулезных мероприятий,рассчитанный на 2006-2015гг. Этот план описываетстратегию, финансовые по-

требности, а также сущест-вующие узкие места и име-ет в виду достижение вданной области во всех ре-гионах мира целей разви-тия, поставленнных в Дек-ларации Миллениума ООН.

Международные стандар-ты защиты от туберкулеза(ISTC) имеют своей цельюоблегчить эффективное

Профессор ДжованниБаттиста Мильори, доктормедицины, сотрудник Цент-ра по контролю лечениятуберкулеза и легочных за-болеваний при Всемирнойорганизации здравоохране-ния ВОЗ сообщает, что наглобальном уровне показа-тели регистрации заболе-ваний туберкулезом воз-растают в среднем на 1% вгод.

Несмотря на то, что стра-тегия DOTS значительноулучшила за последние 10лет контроль над заболева-емостью туберкулезом, ко-личество заболеваний уве-личивается в странах Аф-рики, прилегающих к Саха-ре, а также в странах быв-шего Советского Союза.При этом отмечается суще-ственное превалированиеслучаев заболевания ту-беркулезом с множествен-ной лекарственной устой-чивостью к противотуберку-лезным препаратам, а так-

ДыханиеМеждународные стандарты защиты от туберкулеза (ISTC)

проф.ДжованниБаттистаМильори

оказание высококачествен-ной медицинской помощивсем пациентам без разли-чия возраста и пола. Это 6стандартов по диагности-рованию, 9 стандартов полечению и 2 стандарта, от-носящиеся к обязанностяморганов общественногоздравоохранения.


N E W S

A D V E R T I S E R S I N D E X

Company Page Products/focus

Advanced Instruments 1 Lab equipment

Agfa 3 IT solutions –imaging

Aloka 13 Ultrasound Equipment

BOWA 7 HF equipment

Cardiac Science 17 Cardiology products

Carestream Health 5 Digital mammography

Charité 29 University Hospital Berlin

Detecto 27 Scales

ERS 32 European Radiology Society

Company Page Products/focus

GE 11 Diagnostic mammography solutions

UKE 28 University Hospital HamburgEppendorf

MEDICA 18/19 World Forum for Medicine

Metsä Tissue 12 Hygiene equipment

Sanafontis 31 Private Clinic Freiburg

Schiller AG 15 Cardiac diagnostic solutions

Seca 25 Scales

Siemens Medical Solutions 9 Diagnostic imaging solutions

innovation

buildstalent

myESR.org

Abstract Submiss ionJuly 5 – September 18, 2007

p r e s e n t s i t s a n n u a l m e e t i n gp r e s e n t s i t s a n n u a l m e e t i n g

EUROPEAN HOSPITAL

www.european-hospital.com

EUROPEAN HOSPITAL Publisher,Theodor-Althoff-Str. 39, 45133 Essen, GermanyPhone: +49 (0)201 87 126 850Fax: +49 (0)201 87 126 864e-mail: [email protected]

Editor-in-Chief Brenda Marsh

Art Director Mary Pargeter

Executive Directors Daniela Zimmermann,Reiner Hoffmann

Managing Editor Denise Hennig

Editor Meike Lerner

Russian Supplement Sergey Bezrukov,Fibrotex GmbH, Fischerstr. 140477 DüsseldorfTel: +49 211 550 49 70, Fax: +49 211 550 49 710e-mail: [email protected]

Founded by Heinz-Jürgen Witzke

CorrespondentsAustria: Christian Pruszinsky. Baltic: Andrius Vagoras.Czech Republic: Rostislav Kuklik. France: JaneMacDougall, Keith Halson. Germany: Anja Behringer,Annette Bus, Guido Gebhardt, Heidi Heinhold, MaxHeymann, Holger Zorn. Great Britain: Brenda Marsh, IanMason. Italy: Danilo Camisasca. The Netherlands,Belgium: Michiel Bloemendaal. Poland: Pjotr Szoblik.Spain: Eduardo de la Sota. USA: Karen M Dente, CynthiaE Keen, Ivan Oransky, Craig Webb.

UK editorial address55 Wey Meadows,Weybridge, Surrey KT13 8XY

SubscriptionsJanka Hoppe, European Hospital,Theodor-Althoff-Str. 39, 45133 Essen, Germany

Subscription rate6 issues: 42 Euro, single copy: 7 Euro. Send order andcheque to: European Hospital Subscription Dept

Finishing media technique jöhri, Weilerswist, Germany

Printed by Frotscher Druck,Darmstadt, Germany

Publication frequency bi-monthly

European Hospital ISSN 0942-9085

A member of VVA HealthCare Group

RepresentativesGermany, Head OfficeEuropean Hospital, Theodor-Althoff-Str. 39,45133 Essen, GermanyTel: +49 201 87 126 851-852, Fax: +49 201 87 126 864e-mail: [email protected]

GB, Scandinavia, BeNeLux, FranceSimon Kramer, Willem Alexander Plantsoen 25,2991 NA BarendrechtTel:/Fax +31 180 6200 20e-mail: [email protected]

China & HongkongSun China Media Co., Ltd, Gavin Hua, Room 802, 15th Building, BinJiang Residential Quarter, Dongyuan Road, Futian District, Shenzhen, Guangdong,China, Code: 518031Tel: +86-0755-81 324 036e-mail: [email protected]

IsraelInternational Media, Dep. of El-Ron Adv. & PR Co., Ltd.,Hannah Wizer, 7, Leteris street, Tel-Aviv 64166, IsraelTel: +972-3-6 955 367, Fax: +972-3-6 950 502email: [email protected]

JapanEcho Japan Corporation, Tetsuzo Asoshina,Grande Maison Room 3032-2 Kudan Kita, 1 Chome Chiyoda-KuTokyo 102, JapanTel: + 81 3 3263 5065, Fax: +81 3 3224 2064e-mail: [email protected]

South KoreaFar East Marketing Inc, CH Park,Room 103-1011, Brown Stone,1330, Baekseok-dong, Ilsan-ku,Goyang-si, Gyunggi-do, Korea 410-360Tel: +82 2 730 1234, Fax: +82 2 732 8899e-mail: [email protected]

TaiwanJurassic Communications Corp., Ben Chen,10th Floor-4, No 235, Chang Chuen Road,Taipei 10479, Taiwan R.O.C.,Tel: +886 2 2503 8028, Fax: +886 2 2503 2385e-mail: [email protected]

USA & CanadaMedia International, Hanna Politis, 8508 PlumCreek Drive, Gaitherburg, MD 20882, USATel: +1 301 8696 610, Fax: +1 301 8696 611email: [email protected]

Productivity turnaround. - European Hospital

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