Worm inspires 'comfortable' test for endoscopy

Scientists are developing a new way of carrying out internal examinations on patients - based on a wriggling worm.
In an endoscopy, a long flexible tube is fed into the body. It can be very uncomfortable.
But a team from the Scuola Superiore Sant'Anna, Pisa, found the ragworm, which lives in seashores, could offer a model for a more comfortable test.

They say their device would be able to "pull" itself along, rather than having to be forced into the body.
The team have developed a prototype device, named the Bioloch 1st, which imitates the undulating motion of the ragworm, also known as the paddleworm.
" Ultimately our idea is to turn the current ordeal of the colonic endoscopy procedure into something akin to a pleasurable experience! "
Professor Julian Vincent, University of Bath
The worm, which is often used as fishing bait, moves in wet environments containing large amounts of solid and semi-solid material - similar to that often found inside the body.
The prototype consists of a simple worm with a flexible central spine and paddles sticking out either side along the worm's body. The team are now working on a more advanced version of the device in which the paddles themselves can also move as well as the central spine. Eventually, the device will be motorized.
The team are liaising with a biologist to work out the exact mechanisms for how the ragworm moves.
Paolo Dario, who led the research, said: "The basic concept is to develop a replacement for the current colonic endoscope, which is quite large and stiff, and has to be pushed inside a patient.
"If you can pull a device rather than push it, you can reduce the bending forces and so lessen the chance of damage to a patient's internal organs.
"We looked to nature for a model and chose the paddleworm because it is capable of 'swimming' with ease through relatively soft, unstructured environments."
He said the prototype was quite slow, taking 30 minutes to reach the end of the colon instead of the 10 minutes the conventional type takes.
But he said making the paddles move as well as the central spine of the device should help speed up the 'worm' endoscopy technique.
Versatile
Professor Julian Vincent of the University of Bath, who also worked on the research, said the rag worms have a very different way of moving compared to earthworms.
He said: "The advantage from our point of view is that the paddle worm has a much greater variety of styles of moving, since it can remain straight and just move the paddles, wriggle and keep the paddles still, or wriggle and move the paddles as well. "This gives more versatility in speed and general control. The paddle worm can also build burrows very rapidly.
"So the chances are that a robotic motor based on this design will be more versatile and faster than most others." "Ultimately our idea is to turn the current ordeal of the colonic endoscopy procedure into something akin to a pleasurable experience!

Using video-otoscopy to better manage otitis externa/media in small animal practice

Chronic or recurrent otitis is a common and frustrating disease. A comprehensive approach to identifying and managing all predisposing factors, primary causes, and perpetuating features in each case is the key to successful therapy. In all patients presenting with clinical signs of ear disease, obtain a complete history and perform physical and otoscopic examinations and a cytologic evaluation. Additional testing may include culture and sensitivity, imaging of the tympanic bullae, allergy testing, an elimination diet trial, diagnostics for specific primary diseases (e.g. hypothyroidism), or otoscopy with the patient anesthetized. Further otoscopic evaluation under anesthesia is indicated in patients with suspected foreign bodies, severe acute otitis, purulent otitis, vestibular signs, or recurrent or chronic otitis.

In patients with signs of otitis, video-otoscopy provides several important diagnostic and therapeutic advantages over traditional hand-held diagnostic and operating-head otoscopes. Moreover, video-otoscopy can aid in record keeping and client education.

Improved visualization

Video-otoscopy offers superior optics and magnification to provide greater detail for evaluating the condition of the external canal and tympanic membrane. Even if the membrane was apparently intact on previous evaluation, small perforations and areas of necrosis, sclerosis, or opacification may prompt you to suspect concurrent otitis media. Otitis media was present in 82% of the ears of dogs with continuous or recurrent otitis externa of greater than six months' duration. And the tympanic membrane appeared intact in 27 of 38 ears evaluated under anesthesia with a hand-held otoscope. With otitis externa, the leading cause of treatment failure is unrecognized concurrent otitis media.

Enhanced debris removal

The video-otoscope's configuration of lens, light, and working channel allows you to introduce instruments into the ear without shadowing or blocking the visual field, a common problem with operating-head otoscopes. Forceps, curettes, and catheters less than 5 F in diameter can be used to facilitate debris removal and sample collection. For irrigation during examination, sterile saline solution is safe and cost effective, and it permits continued visualization while the probe is immersed. Such visualization is not possible with operating-head otoscopes, because the light from the ear cone's base reflects off the fluid-air interface when the canal is filled with solution. Constant visualization permits you to target debris, enhancing the accuracy and effectiveness of cleaning while minimizing the risk of iatrogenic injury to fragile structures within the tympanic cavity.

Increased accuracy

In the case of otitis media with an apparently intact membrane, the video-otoscope can be used to more accurately direct diagnostic myringotomy and sample collection from the middle ear cavity for cytologic evaluation and culture and sensitivity. Such sample collection is useful because in as many as 89.5% of cases, the species or antibiotic sensitivity of bacteria obtained from the middle ear differs from that obtained from the external canal.,

When performing a myringotomy, be careful to aim for the caudoventral region of the pars tensa, avoiding the germinal epithelium in the area where the malleus attaches. With a video-otoscope, practitioners can perform this technique with more ease and confidence, because lighting and visualization are better.

Summary

The video-otoscope facilitates diagnostic and therapeutic procedures: It improves direct visualization, so you can better assess the external ear's condition and the tympanum's patency. The video-otoscope also allows for more precise sample collection for cytology and culture, biopsy, and myringotomy, and it enhances flushing and debris removal. Photographs and video recordings, other capabilities of video-otoscopes, provide a permanent visual record of the condition of a patient's external canal and tympanum. And a photograph can convey a patient's condition better than a verbal description when you re-evaluate a case, advise a client, or consult a colleague.

http://www.karlstorzvet.com/article_video.html

Endoscopy in veterinary

Endoscopy is performed with either a rigid or flexible endoscope. Flexible endoscopes consist of a long, flexible tube with a bending tip at the end that enters the body, an eyepiece, and a control section. The tip of the endoscope is manipulated using a control knob in the hand piece. In addition to the fiber bundles which provide the light source, two channels are present within the endoscope. One channel permits various endoscopic tools to be passed and fluids to be suctioned or samples taken. The other allows air or water to be passed into the studied place or wash away mucus from the viewing port. Special video cameras can be attached to the endoscopes which allow viewing on a television screen. Rigid endoscope cannot be used in some areas, such as the stomach because it does not have the bending tip, so it cannot be flexed to allow examination of all parts of the stomach.

Endoscopy can be used in different areas. Flexible endoscopy - Bronchoscopy: an exam of the lower airways; Colonoscopy: an exam of the transverse colon, ascending colon, cecum, large bowel, and rectum; Endoscopy: an exam of the stomach, and upper intestines. Rigid endoscopy - Arthroscopy: an exam of soft tissue structures and joint cartilage. Decreased damage to the joint and shortened recovery times are two advantages of arthroscopy over arthrotomy (surgical exam of the joint); Cystoscopy: an examination of the vagina, urethral opening, urethra, bladder, and ureteral openings; Laparoscopy: an exam of the abdominal cavity performed through a small incision in the wall of the abdomen or through the navel; Proctoscopy: an exam of the large bowel and rectum; Rhinoscopy: an exam of the nasal cavity and nasopharynx (junction between the nasal area and the back of the throat).