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Medical technology Trends towards minia-turisation and digitisationwill continue, says ZVEIAs in past years, this year’s MEDICA is one of themost important stages for the medical technologyindustry. International manufacturers will do a songand dance to dazzle the international clientele. AsManaging Director of the German Electrical andElectronic Manufacturers’ Association (Deutscher Zentralverband Elektrotechnik-und Elektronikindustrie e.V. – ZVEI), Hans-Peter Bursig, is well aware of thistrade fair’s role for the export-oriented med-tech companies, particularly thosein Germany. In an interview with Meike Lerner, of European Hospital, hehighlighted the position and perspectives of German medical technology firmsand the fair’s significance for the domestic med-tech industry.

Hans-Peter Bursig,Managing Director of ZVEI

‘Medical technology is certainly oneof the most important groups ofexhibitors at MEDICA, be it in termsof space – four halls are dedicatedexclusively to this segment – or ofvisitors. In visitors’ surveys, for yearsmedical technology has been namedamong the top-ranking points ofinterest,’ Hans-Peter Bursig pointedout. ‘Last year’s trends will no doubtcontinue for years to come: miniatur-isation and digitisation. The productsare becoming increasingly compactand the importance of software andthe electronic components to controlthese products is growing. It also

means that the products becomemore modular and this can be com-bined into complex systems that aretailored to the customer’s needs andspecifications.’European Hospital: How well are

German medical technology

companies positioned

internationally?

H-P B: The German medical technol-ogy industry is very well positioned,internationally as well as in Europe.Depending on your point of view,German manufacturers rank numberone to three. In Europe, we are no

2

N E W S

continued from page 1 CONGRESSES & EVENTSWednesday 14 November 2007

MEDICA CONGRESS14:30-17:30 CCD Pavilion, 1st floor, room 17MRSA – an interdisciplinaryproblem ● MRSA in in-patient nursing ofgeriatrics, by Violets Lorecka,Kassel● Hygiene measurements andepidemiology during occurrence ofMRSA, by Dr. MarkusSchimmelpfennig, Kassel● Pharmaco-therapy for MRSA:possibilities and limitations, by Dr.Hans-Walter Schmitt, Kassel

MEDICA MEDIA WORKSHOP14:00-16:00Hall 16, booth A 05, workshoproomTeleHomecare – Do nursing robotsoffer new possibilities? Chairman:Dr Pablo Mentzinis, BITKOM, Berlin

MEDICA PLUS12:00-13:00 Hall 1, 1st floor, room 111EPC/RFID and barcode in action –for your transparent healthcaresupply chain. Organiser: GS1Germany GmbH

MEDICA VISION11:00-13:00 Hall 3, booth H 92Diagnostics and therapyperspectives: new imagingdevelopments ● Conceptual changes in oncologytriggered by molecular imaging,Prof. Dr. Ottmar Schober, UniklinikMünster● From molecule to routine cardiacdiagnostics, Prof. Dr. Dr. WolfgangBauer, Uniklinik Würzburg● Sonohistologie – a histologicalprocedure for ultrasoundcharacterisation of tissue, Prof. Dr.Helmut Ermert, Ruhr-Universität-Bochum● US-guided navigated intervention,Prof. Dr. Martin Overhoff, FHGelsenkirchen● 3-D ultrasound imaging innavigated orthopaedic surgery,Prof. Dr. Georg Schmitz, Ruhr-Universität Bochum● Radiology in the third millennium,Prof. Dr. Hans-Peter Meinzer,DeutschesKrebsforschungszentrumHeidelberg

13:00 – 14:00Hall 3, booth H 92Diagnostics and therapyperspectives: new developments incardiology ● Monitoring chronic heartinsufficiency: development of apulmonary implant , Prof. Dr.Thomas Schmitz-Rode, RWTHAachen● Vital sensor networks for closemonitoring of patients with anacute cardinal risk constellation,Christian Hofmann, Fraunhofer IIS,Erlangen● From cell biology to healthservices research in cardiology,Prof. Georg Ertl,Universitätsklinikum Würzburg● Aortic stenosis: new possibilitiesof percutaneous aortic valvereplacement, PD Dr. Stefan Sack,Universitätsklinkum Essen

COMPAMED13:25 – 16:30Hall 8a, booth G 40COMPAMED Forum ‘High-tech forMedical Devices’ ● Applied Nanotechnology: fromexperimental approaches to realproducts, Dr. med RainerHanselmann, sarastro GmbH● Nano2Life: a landmark in EUnanobiotechnology, Dr. Klaus-M.Weltring, Gesellschaft fürBioanalytik-Muenster e.V., Münster● Transponder-based microsystemsfor medical applications, Dr. UweSchnakenberg, RWTH Aachen● Creating value throughintellectual assets, Dr. RobertHarrison, Sonnenber FortmannPatent- & Rechtsanwälte, München● European micro/nano atlas formedical devices, Dr. Uwe Kleinkes,IVAM Research, Dortmund● Application of plastic in medicaltechnology – an overview: TorstenUrban, Kunststoff-InstitutLüdenscheid, Lüdenscheid

®

doubt the leading country. Interna-tionally, we are behind the US, nev-ertheless German companies do wellon the US market. However, Ger-many is no longer the internationallead-market for medical technology.We have to bring innovative productsto the domestic market much faster.If we fail to do so, we will run therisk of losing our competitive edge.

For German companies, MEDICAhas developed into a platform fromwhich they face up to internationalcompetition – only on the Germanmarket. Today, this is the interna-tionally leading fair where customerscompare German companies with

their international competitors. Forthe German medical technologyindustry, which heavily relies onexport, it is an enormous advantageto have the major fair right on thedoorstep.What do you expect from this

year’s MEDICA?

H-P B: The prime task of such fairs isto network, to maintain contacts aswell as initiate new business. Overthe last few years, MEDICA has donewell in this respect. German cus-tomers have displayed increasedinterest in innovative products andtheir potential to improve efficiencyand quality. Thus, this trade fair isalso an indicator of the investmentclimate in Germany.

Which products and

technologies offer the most

potential for German med-tech

firms?

H-P B: In general, German medicaltechnology is strong in the capitalgoods sector, where quality and ser-vice during the entire life cycle play acrucial role. Today, modern health-care and the cost-efficient operationof hospitals and doctors’ offices areinconceivable without these prod-ucts. The capital goods sector iscomplemented by IT solutions andproblem-specific packages fordefined clinical issues. German med-ical technology is also well posi-tioned in the market for efficiency-and quality-enhancing solutions.

3

N E W S

CLB International BV (Nether-lands) has designed the WiFiMessenger (CLB-WMG) specif-ically for use in the healthcaresector. The firm reports thatthis well-designed, robustdevice works on any existingwireless (LAN) infrastructureenabling full duplex communi-cation via speech or video.The device may also be usedfor data transfer.

The WiFi Messenger fea-tures a dual display, freely pro-grammable buttons, multiplealarm types, location detec-tion, a telephone book andspeech recognition. CLB alsooffers other IP solutions forhealthcare – including a nursecall system, which is able toreport alarms from differentmedical devices and has beencertified in accordance withthe European Guidelines forMedical Devices (CE 0344).

New medical technology centreto target artificial organs

Switzerland - An Artificial OrganCentre for BiomedicalEngineering Research has beenset up at the University of Bern,drawing together its establishedareas of expertise in medicaltechnology.

Housed in the university’sMedical Faculty, the ARTORGCentre is active ininterdisciplinary teaching andresearch and development,focusing especially on artificialorgans. Research groups fromunits within the Medical Facultyand other faculties at theUniversity of Bern and otheruniversity institutions anduniversities of applied scienceswill work together in the newcentre.

Medical technology hasbecome an established high-profile discipline in theUniversity of Bern’s Strategy2012. The importance andexcellent internationalreputation of Bernese medicaltechnology is based on thetraditionally high standards ofBern’s teaching hospitals, itscontribution to the NationalCentre of Competence inResearch Co-Me, the Technologyfor Humans research focusprogramme at the BernUniversity of Applied Sciences(BFH) and the commerciallysuccessful medical technologycompanies in the Espace regionof central Switzerland.

Close co-operation betweenclinicians, technologists, andindustryAccording to Martin Täuber,Dean of the Medical Faculty,this new platform will co-ordinate existing projects andclinical approaches that involve

artificial organs and medicaltechnology, yield improvedtechnological support andcross-fertilization of projects.The scientific programme ofthe ARTORG Centre will beestablished and implementedby 11 newly created assistantprofessorships. The researchgroups will focus on thefollowing artificial organs andspecialist areas:

● Blood vessels● Bladder● Ear● Eye● Heart● Kidney● Liver● Lung● Pancreas● Spine● Implantation

technology of artificial organs

Medical technology research anddevelopment at the ARTORGCentre will involve close co-operation between clinicians,technologists, the medicaltechnology industry and otherSwiss technology institutions. Inparticular, the centre will workclosely with the Technology andIT Faculty of Bern University ofApplied Sciences. The ARTORGCentre’s involvement in the

specialist Master of Science inBiomedical Engineering degreeprogramme and PhD programmeof the Graduate School forCellular and Biomedical Scienceswill generate additional synergiesbetween research and teaching.The Director of the Institute forSurgical Technologies andBiomechanics at the MedicalFaculty is responsible for theoperational management of thecentre. A scientific committeeappointed by the universitymanagement is responsible for thestrategic leadership of theARTORG Centre and also for thequality of its science.Details: http://www.unibe.ch

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4

U L T R A S O U N D

TheACCUVIX V10The advanced ultrasound system ACCUVIXXQ has been widely recognised worldwide forits advanced technology and stability, but anew ultrasound system is about to steal itsthunder,’ its manufacturer reports.

Produced by MEDISON Co Ltd (CEO: J. B.Choi) Accuvix XQ was ranked, according tothe Klein Report, in second place in thenumber of units sold in 2005 as well as 2006 inthe US$200 million American obstetrics andgynaecology ultrasound market. The XQ hasnow been superseded by the latest in the line:the Accuvix V10.

‘The brand new Accuvix V10 integratesvarious proven technologies from the existingAccuvix line,’ said Mr Oh, project leader ofV10 in the Medison R&D department.‘However, this unit upgrades accuracy andefficiency with new technologies, whileoptimising user convenience with itsergonomic design.’

The V10’s high definition 17” LCD monitorprovides optimised resolution of 2-D, 3-D and4-D image quality. The V10 has various built-in

The advantages ofultrasound forpaediatric diagnosis

A presentation for the 31st tri-national DEGUM, ÖGUM, andSGUM conference in Leipzig,

Germany, by Axel Feldkamp MD(below), Chairman of the DEGUMpaediatrics division, and Director

of the paediatrics departmentat Duisburg Hospital

Ultrasound is the mostimportant imaging techniquein paediatrics – more so thanin any other branch of

medicine. This is attributable to anumber of factors. X-ray exposureis a more significant risk factorfor paediatric patients than foradults by virtue of the cumulativenature of X-ray dosages, thusmaking paediatric patients morelikely to receive a higher dose ofradiation. Moreover, some typesof immature tissue are moresusceptible to radiation. Thus it isessential to avoid the use of X-rays in children and young adults.

Ultrasound scanners have nowevolved to the point where the

image quality they deliver obviatesthe need to use any other imagingtechnology. Various types of heartcatheterisation can now be realisedusing ultrasound in lieu ofradiography. Elaborate high-radiation imaging procedures forthe urinary tract are increasinglyreplaced by the use of ultrasoundcontrast media. Complex imagingof skull pathology in paediatricpatients can now be realised usingultrasound rather thanradiography.

Another advantage of ultrasoundexaminations lies in their readyavailability. In neonatology inparticular, examinations ofneonates in incubators areindispensable, since moving thechild from one place to another,wrapped in a textile, wouldconstitute an extreme risk. Inaddition, thanks to the progressiveminiaturisation of ultrasoundscanners, paediatric ultrasoundexaminations can be realised prettymuch anywhere and at any time.

High resolution ultrasoundscanner heads (ideal forneonatology by virtue of theirrelatively shallow penetrationdepth) often produce image quality

that is unmatched by any othermethod. In some cases, onlyultrasound can detect congenitalheart defects, brain morphologydefects, cranial bleeding, andhaemodynamic complications.Although MRI provides outstandingimage quality in infants, theexaminations are lengthy and aninfant must be either anaesthetisedor heavily sedated.

Ultrasound is taught in paediatrictraining programs owing to theextreme usefulness of thetechnique. Consequently,ultrasound is widely available andcan be used for screening purposes.For example, the current practiceof doing a hip screening for allnewborns has reduced to aminimum the number of hip defectsrequiring surgery.

Thus ultrasound can be regardedas the paediatric imaging techniqueof choice for the following reasons:● the child is not exposed to

radiation● ultrasound devices can be

deployed just about anywhere ● ultrasound image quality

constantly improves, thanks tothe use of high-resolutiontransducers.

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U L T R A S O U N D

In emergencies, the first fewminutes are vital, and havingan ultrasound device for initialdiagnosis could prove

lifesaving. Speaking of a newportable ultrasound device fromSiemens Medical Solutions KlausHambüchen, head of theUltrasound group of SiemensMedical Solutions, said: ‘Thismultifunctional system helpsmedical personnel to make theright decision within that timeframe.’ Although the portabledevice to which he refers — theAcuson P10 – was designedspecially for acute care, e.g. inthe ICU, an ambulance or medicflights, it is also suitable as a

functions enabling speed andaccuracy. Users can save imagesand re-view them with ease,enabling more efficientmanagement of patients andeffective diagnoses, Medison adds.‘Accuvix V10 offers quality ofperformance and ease of use toclinicians in a range of fields,including, but not limited to,obstetrics, gynaecology, radiology,cardiology and urology.’

Medison, based in Seoul, Korea,was founded in 1985 andpioneered the first commercialreal-time 3-D ultrasound scanner.Today the firm manufacturesspecialised diagnostic ultrasoundsystems ranging from portable todigital 3-D and 4-D, and has salesoffices in more than 100 countries. Contact: MEDISON Co Ltd, Binie

Kim/Marketing Dept.

Telephone: 02-2194-1092

E-mail. Bini99@medison.com

Corporate and product information:

www.medison.com.

A highly portable mini-ultrasound deviceBarely biggerthan yourBlackBerry andweighing just500 grams

nursing staff or paramedics canperform the initial importantexamination in the emergencyward. Acuson P10 is usedprimarily to triage patients. Thisensures that each patient receivesthe treatment necessaryaccording to the seriousness ofthe illness or injuries sustainedwithin a shorter time period thanbefore,’ Siemens reports.

diagnostic tool in the first hour incardiac emergency care, but thecompany adds that it is alsosuitable for surgery, inobstetrics/gynaecology or inveterinary medicine.

‘As an additional diagnosticdevice, Acuson P10 supplementsinitial examinations in emergencymedicine comparable to a visualstethoscope. When needed,

The device will go on sale thisyear, with its black & whitescreen, but an additional version(still pending) will have a colorDoppler function. Special lithiumion accumulators enablecontinuous scanning for about onehour.

Images from the Acuson P10 canbe stored in the HospitalInformation System (HIS).

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design. The new ACCUVIX V10 contains cutting-edge

2D, 3D and 4D image technologies: Dynamic MRTM,

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VOCALTM. The innovative system platform ensures

optimal patient throughput. A 17-inch flat-panel

display, set on an articulating arm, delivers superb

operator convenience and high-resolution images.

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The Sarano digital, black and white ultrasound system, made by Shimadzu,is on show at MEDICA. The company reports: ‘This all-round system ombines the latest in hardware, software and probe technology, generating high-performance imaging quality as well as improving the digital handling of clinical data. The Sarano is suitable for hospital use and private practice – for stationary as well as ambulant applications. A large number of medical fields, such as radiology, internal medicine, urology, gynaecology and obstetrics will benefit from this economical and efficient instrument.’

High-res imagesThe core technology for the improved transmission quality and accurate display of the ultrasound image data is the newly developed digital beam former with DBT technology. ‘It processes and transmits data ten times faster without any noise. In this way, even the most delicate tissue structures can be shown through high-resolution ultrasound images.’

In addition the system includes micro-imaging array technology for a maximumfrequency of 15 MHz. The five-tier fine-tuning of the probe frequency and consequently the diagnosis-specific settings bothcontribute to the improved images, the maker points out. ‘Tissue Harmonic Imaging (THI) increases the spot and contrast resolution in the B-mode under difficult diagnostic conditions. Fast image iteration frequencies, focusing on the pixel level as well as high image dynamics, further increase authentication and diagnostic confidence.

6

U L T R A S O U N D

World’s 1st Cardiac motion evaluationin minutesToshiba’s new Artida Ultrasound system is the

world’s first ultrasound system that can track and

display myocardial wall motion three-dimensionally.

‘I can obtain several parameters in just a few minutes

— longitudinal strain, radial strain, circumferential

strain, rotation, shear, twist and torsion of every

cardiac segment,’ confirmed Leopoldo Pérez deIsla MD PhD FESC, of the Cardiovascular Imaging

Unit in the Cardiovascular Institute at the Clínico

San Carlos Hospital, Madrid.

The system has a wall motion tracking feature that

allows the user to obtain angle-independent,

quantitative and regional information about

myocardial contraction.

3-D Speckle This new diagnostic tool was designed to improve

case assessments. Dr Pérez explained its value: ‘The

heart has three dimensions, so heart motion does

also happen in three dimensions. So far we can assess

wall motion quantitatively only two-dimensionally,

not taking the complex twist and shear motion of the

heart muscle into account. The new 3-D-speckle

technology (developed by Toshiba) allows us to

follow speckle in three spatial directions. What’s

more, the acquisition and analysis of the data sets is

easy and fast, using the 3-D data set. The new

technology provides a fast and global approach to the

analysis of these parameters and avoids its under-use

due to the time consuming 2-D derived speckle

technology.’ Therefore, arbitrary views of the heart

The Sarano digital US

The systemalso offers awide range oflightweight,high-resolutionelectronicprobes, and issaid to be idealfor ambulantand stationaryapplications

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7

U L T R A S O U N D

Dr Leopoldo Pérez

that are unavailable in 2-D

imaging can be obtained for

surgical planning.

Additional featuresArtida’s new SmartCore

engine employs with the

processing power of more

than 80 processor cores

interconnected by a fast

digital system interface, and

that means the Artida can

obtain clear echocardiographs

and a high diagnostic

accuracy, Toshiba pointed

out. ‘A MultiCast beamformer

uses advanced digital signal

processing to control the

shape of the ultrasound beam

more precisely and flexibly

than in comparable systems.

SmartFocus is the first 4-D

technology applied to

conventional 2-D imaging

transducers that offers a

finer and more uniform

ultrasonic beam in all three

dimensions, resulting in an

improved image quality from

the very near to the very far

field.’

The new Tissue

Enhancement Mode, which

suppresses white noise

effectively, enhances image

uniformity and endocardial

border delineation could be

strengthened, the company

added, particularly in

difficult-to-scan patients.

system‘The panoramic angle of up to

198° at endocavity diagnosisenables excellent orientation.User-specific optimization ofimage resolution is possible viathe frequency spectrum of 2 – 15MHz and the 5-tier frequencymode.

Digital platformDue to the fully digital and ‘open’system architecture and highperformance the equipment isprepared for future developments.It can be integrated in a LAN aswell as a DICOM high-performancenetwork. Clinical images aretransferred to a PC as JPG orbitmap data, and also can bestored on a USB stick for transferto a PC outside of the network orto give to a patient.

The newly designed keypadmakes neighbouring keys easilyaccessible via the centraltrackball, Shimadzu reports. ‘Themost frequently usedfunctionalities are arranged withineasy reach. Diagnosis specificpresettings enable fast andtargeted operation of the system.Freely programmable functionkeys support individual physicianrequirements and optimizeworkflow.’Further details: www.shimadzu.de

Gama Healthcare has developed an advanced innovative wipe —Clinell Sporicidal — which, the company reports, is the world’s firstperacetic acid generating wipe specifically designed to deal withspores. The wipe was developed by a team of medical doctors andcontains patent pending technology designed around the stability ofthe peracetic acid, the company adds.

‘Clinell Sporicidal offers an easier and much safer option than thechemicals currently recommended to deal with spores such asChlorine and Glutaraldehyde based compounds. The wipe isactivated with the simple addition of water, which producesperacetic acid instantaneously to levels which are proven to kill all

SPORES SIMPLY WIPED OUTknown germs. Peracetic acid works extremely well in dirtyconditions (unlike Chlorine) and can be used directly on fresh bloodspills, which will activate the wipe immediately without the needfor water. The fumes produced are non-toxic, which allows for usein close proximity to patients. The breakdown products areenvironmentally friendly and contain no alcohol or organic solvents.

‘Clinell Sporicidal is the most powerful wipe to ever be createdand its development constitutes a major advancement in wipetechnology and infection control. In addition, it is set to becomethe gold standard for dealing with spore outbreaks in hospitals andhealthcare institutions across the world.’

HYGIENE

8

U L T R A S O U N D

In the ongoing quest for technologies thatresult in as little damage as possible whenused in surgery, therapeutic ultrasoundstands out because it can offer what noother technology does: non-invasive,bloodless ablative surgery. Whether it is anemergency operation to staunch deepinternal bleeding, or an elective procedureto remove a tumour, ultrasound has beenshown to provide an effective method thatcan deliver ablative energy to deep-seated

Paediatric interventionalultrasound (‘Safety first’)By Professor György Harmat MD (right), Director General of theBudapest Municipal Council Pal Heim Children’s Hospital, HungaryWith the rapid development of

new instrumentation it is now

possible to carry out interven-

tional procedures on ever

younger children and even

neonates.

Ultrasound guided therapeutic

interventional procedures may

also be carried out in certain

clinical circumstances where the

alternative would be operative

intervention e.g. the drainage of

intra-abdominal abscesses or

accumulated peritoneal fluid. In

many cases this will result in a

definitive cure.

The most frequent inter-

vention is the parenchymal

biopsy.

In childhood the pain sensitiv-

ity is always individual. Sudden

artificial movements are possi-

ble. We perform biopsies in the

operating theatre, with US guid-

ance attachment.

During our 17-year experi-

ence, we have undertaken 366

procedures on 125 children.

Biopsy samples should be

taken from children between

two breaths with suspended

ventilation. The anaesthetist is

able to manually ventilate the

child allowing the procedure to

be performed in the 20 to 45 sec-

ond pause between ventilations.

Using this technique we have not

observed any damage to the

solid abdominal organs.

During sampling with a special

True-cut needle of 18G, the

accurate place and dimension of

the invasion can be chosen. Con-

trol examinations have been

performed after 1, 12 and 24

hours of the first intervention.

Other interventional proce-

dures, such as drainage, peri-

toneal lavage, pleuritis punc-

tion, abscess or pseudocyst

drainage or antibiotic treat-

ments are also performed under

general anaesthesia.

In our series, the clinical indi-

TRAUMA CAREUsing high energy ultrasoundto control internal bleeding

cations for interventional proce-

dures have been for biopsy intra-

hepatic cholestasis with portal

fibrosis, hepatic tumours such as

hepato-blastoma, some at a very

early age, chronic persistent hepati-

tis, Niemann-Pick storage disease,

giant cell hepatitis, nephrosis,

nephritis, ovarian tumours, neurob-

lastoma and different other

tumours, as well as varying intra-

abdominal abscesses requiring

drainage, peritonitis, pancreatic

pseudocyst.

Taking ’safety first’ as our most

important consideration, we have

found a very low frequency of minor

complications in our cases. We have

detected some capsular, subcapsu-

lar or perirenal haemorrhages, how-

ever these disappeared within 24

hours and could not be observed at

follow up. Once, after biopsy, a tem-

poral blood clot was detected within

the gall bladder. We have had no

major complications.

ConclusionsIn children, general anaesthesia

should usually be used to avoid

involuntary movements.

An early diagnosis of serious ill-

nesses is possible by this very suc-

cessful combination of ultrasound

and biopsy. It does not cause any

complications, and due to general

anaesthesia during the procedure,

children have not suffered. By

applying instrumental breathing,

damage of the parenchymal tissues

can be avoided.

It should be emphasised again

that ultrasound guided interven-

tional procedures in children should

always be performed with great

care. The use of general anaesthesia

minimises complications and this is

a significant difference in practice

between adults and children.

tissues, while requiring no incision in theskin or surgical exposure of the tissues ofinterest.

This technology, dubbed High IntensityFocused Ultrasound (HIFU), relies on theability to focus ultrasound waves on aregion about as small as a grain of rice,positioned at any desired depth in softtissues. The main difference betweenHIFU and diagnostic ultrasound imaging isin the levels of applied acoustic intensity,

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U L T R A S O U N D

RADIO-SURGERY TO REPLACE A SCALPEL The radio-surgical device radioSURG2200 has been developed to providethe surgeon with a unit suitable for anysurgical procedure, the manufacturerMeyer-Haake reports. Due to a new,innovative technique, minimal heat isproduced, and an incision can be madewithout any pressure or tension. As aresult, enormous precision is achievedand the surrounding area experiencesno thermal damage, the companypoints out.

A further asset: tissue samples canbe histologically examined. Surgeons can examine this device atMEDICA — Hall 5. P21Details: www.meyer-haake.com

Careful removal of a nevus to obtain beard growth

By Shahram Vaezy, AssociateProfessor of Bio-engineering atthe University of Washington,Seattle, and Vesna Zderic,Research Associate at theCentre for Industrial and MedicalUltrasound, Applied PhysicsLaboratory, George WashingtonUniversity, Seattle

while both use similar frequencies inthe range of 1-10 MHz. In ultrasoundimaging, low intensity waves ofabout 0.1 W/cm2 are used to reflectfrom tissue structures to be resolvedin the image, and in HIFU, highintensity waves of about 1000W/cm2 are used to cause instantcoagulative necrosis and tissuedisruption.

The application of HIFU to thehaemorrhage control problem (oftencalled acoustic haemostasis) stemsfrom the need to have an effectivemethod to stop bleeding in ‘thegolden hour’ after severe traumaticinjury, involving profuse bleeding.Many trauma patients sufferinginjuries with high bleeding ratesexpire during transportation tohospital, or on the operating table,due to haemorrhagic shock(particularly true for battlefieldvictims).

In general, cessation ofhaemorrhage using extrinsic,interventional methods is possiblewith delivery of energy to bleedingtissues, i.e. cauterisation. We haveshown in preclinical studies in largeanimals that bleeding from injuriesof liver, spleen, kidneys, and majorblood vessels (femoral and carotidarteries, jugular vein, aorta, etc) canbe stopped using HIFU within aminute or so. The mechanisms ofacoustic haemostasis includethermal and potentially mechanicaleffects. Temperatures above 70degrees Celsius can be produced inthe targeted tissue within seconds.Further, it appears that boiling ofinterstitial fluids and blood, as wellas acoustic cavitation (i.e. formationof microbubbles at the focus due tomechanical HIFU effects) are alsoinvolved in acoustic haemostasis.The biological effects are believed toinclude coagulative necrosis due tohigh temperatures, and mechanicaldisruption of tissue structurespotentially leading to release oftissue factors enhancing thecoagulation, coagulum andthrombus formation at a wound site,tissue fusion via collagen and elastinremodelling, and fibrin plugformation.

HIFU integrated with ultrasoundimaging offers a unique potential fordeveloping a small portable devicethat can be brought to the site of anaccident. Such a device can be usedto detect and localise the bleedingsite using ultrasound imaging and tostop the bleeding using HIFU, all inreal-time, using a seamless image-guided therapy system. Currently,the ultrasound imaging systems canbe as small as a laptop and the HIFUdevices can fit in a small suitcase.

Further development of thesedevices would provide automationof the bleeding detection andtreatment methods to facilitate itsusage by paramedics and other firstresponders. A haemorrhage controldevice for use outside hospitalsettings shortly after injury occurs,and capable of site-specifictreatment, could provide a life- andlimb-saving tool in traumamanagement.Contacts: adasi@u.washington.eduvesna@u.washington.edu

At GE Healthcare, we believe an innovative idea can achieve transformational results. We focus on Ultrasoundapplications that will create new clinical value for you and your patients. Then, we bring them to life throughannual breakthroughs within our LOGIQ¤, Vivid¤ and Voluson¤ product families.

It s all about giving you the freedom to see Ultrasound in brand new ways. Volume ultrasound. Compactultrasound. Powerful IT solutions. All the latest technologies from GE - designed just for you. Imagine the effect.Ultrasound Re-imagined

For more information about GE s ultrasound products, please visit us online at gehealthcare.com.

The breakthrough effect

GE Healthcare

' 2007 General Electric CompanyGE Medical Systems Ultrasound & Primary CareDiagnostics, LLC, a subsidiary of General ElectricCompany, doing business as GE Healthcare.

GE Ultraschall Deutschland GmbHBeethovenstr. 239, D-42655 SolingenT: 49-212-28 02-0, F: 49-212-28 02-28

GE imagination at work

Please visit us at MEDICA -Hall 10/Booth number A56

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U L T R A S O U N D

The ProSound �7

Aloka’s powerful yet compact andfriendly ultrasound system for dailypatient care

Visit Aloka at Medica Hall 9 Booth A74

Today, ultrasound is present in most specialised medical fields, and even used in smallpractices. However, in terms of quality, when using ultrasonic equipment in the low pricesegment, users often had to compromise in terms of quality. This has been not only to do withresolution, but also the granulation typical in an ultrasound image.

This year at MEDICA, GE Healthcare is introducing its new ‘economy class’ ultrasounddevice that, GE reports, integrates high-performance with high-end technology.‘The LOGIQ A5 Primare permits only monochrome B-images - but these areof a very high quality, because the hard- and software are taken fromthe considerably more expensive medium-class system LOGIQ P5. Thetwo-dimensional B-mode provides an optimised view of the anatomicalconditions as well as, if necessary, of pathological changes in organs andtissues. The possibility of Doppler ultrasound to record the blood flow speedin vessels has foregone in the member of the LOGIQ family.’

Thanks to its refined multiple focusing, the system delivers a local resolutionthat corresponds with that of the high-end class and can also be optionallyequipped, in the ‘Premium’ version, with GE’s unique speckle reduction, thecompany adds. ‘In this connection, the graininess typical of the ultrasonicimage is recognised as an artificial phenomenon and eliminated. The result isan amazingly realistic representation of the tissue and its fine structures,which comes close to that of the MRT. New image processing techniquessuch as Phase Inversion Harmonics or CrossXBeam provide a cleardefinition of boundary surfaces, reduce artefacts as well as thebackground noise, in order to distinguish more clearly between cysticand echo poor lesions more clearly.’

In addition to routine applications in general and internal medicine,the LOGIQ A5 Primare is suitable for more specialised investigationse.g. in orthopaedics, rheumatology or paediatrics, GE points out.

reduce the time required for aseries of examinations. Acomprehensive data managementsystem with high-level DICOMnetwork compatibility providesefficient imaging and dataadministration.

With important breakthroughflow display technology, thesystem offers Directional eFLOW,D-eFLOW, a new innovative bloodflow capture and display modeoffering increased accuracy inblood flow detection of lowvelocity flow as well as acuteacceleration non-invasively.

Aloka has also developed atechnique that not only helpsearly detection of atherosclerosisbut also helps to identify patientswho are prone to the indicationeven before the usual clinicalsymptoms appear. Echo tracking,eTRACKING, is a proventechnique that picks RF echosignals from blood vessels, tracksthe motion of the vessel walls,and measures changes in blood

Premium GE ultrasound technologyat ‘economy class’ cost

The new system was developed to meetthe needs of modern imagingdepartments for daily patient carewhere examination time and workflowmust be continuously optimised. Todeliver higher patient throughput, theProSound �7 offers a user friendlydesign for multiple users. It consists ofuser-customisable panel switches, avirtual keyboard to make entries viathe touch panel, the integration of again knob and freeze switch, which caneasily freeze images, and fast access toall frequently-used keys, arrangedaround a trackball. The reportingfunctions for individual applications

NEWLYLAUNCHED

With over 200,000 ultrasound systems deliveredworldwide, ALOKA, which has been a leadinginnovator in ultrasound for half a century, continuesto enhance the ProSound family of high performanceproducts. At MEDICA this year, the company isintroducing its latest development: the ProSound �7.To deliver high definition images on a LCD monitor,ease of use and a compact form design, theProSound �7 combines innovative technologies withrenowned reliability and high industry standards ofthe ProSound platforms.

NEW

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U L T R A S O U N D

vessel diameter. Importantparameters such as Pulse WaveVelocity, Augmentation Index,and Stiffness are measured inone step, non-invasively, with anextremely high degree ofaccuracy.

ProSound �7 offerssophisticated cardiovascularexamination functions such asthe KI/A-SMA function thatautomatically traces theendocardium for quantitativeassessment of wall motion basedon the area change of the cardiaccavity segments or a TDIanalysis, which let the region ofinterest follow the same point onthe myocardium at any timephase of the cardiac cycle; thisenhances the accuracy of wallmotion velocity analysis.Accuracy is also ensured for theasynchrony measurement,because of the high frame ratewhich leads to an optimal timephase analysis in the M-mode,the D-mode and TDI.

Areas of use: The ProSound �7 offersultrasound imaging applicationsin radiology, internal medicine,obstetrics & gynaecology,cardiovascular and otherspecialist ultrasound-guidedprocedures. Full details: www.aloka-europe.com

blood flow to oxygen deprivedtissues. The sub-micron size ofMRX-801 microbubbles mayallow them to penetrate a bloodclot, so that when ultrasound isapplied their expansion andcontraction, or cavitation, canbreak the clot into very smallparticles, ImaRx reports. ‘ImaRxis conducting an ongoing PhaseI/II multinational clinical trialevaluating its SonoLysis+tPAtherapy to treat patients withacute ischemic stroke.’

A new research collaboration tostudy the potential of microbubblesand ultrasound to treat ischemicstrokes has been establishedbetween ImaRx Therapeutics, abiopharmaceutal company inTucson, Arizona, and the Philips’Medical Systems division inAndover, Massachusetts.

Philips ultrasound technology is tobe used within the ImaRx’sSonoLysis programme* to developnew treatment for acute ischemicstroke. Under the agreement, Philipswill provide ultrasound devices andtechnical assistance to ImaRx duringits laboratory and preclinical studiesusing the ImaRx’s proprietary MRX-801 microbubble technology todetermine the optimal ultrasoundparameters to be used.

The vast majority of strokes,According to the American StrokeAssociation, about 87% of strokesare ischemic, i.e. caused by bloodclots that block normal blood flow inbrain vessels. Additionally,Datamonitor reports that less than6% of the ischemic stroke patientsreceive the thrombolytic drug tPA,the only drug currently approved bythe FDA to treat acute ischemicstroke.

‘This research collaborationrepresents a significant step forwardfor ImaRx’s SonoLysis programme,’added Bradford A Zakes, Presidentand CEO of ImaRx Therapeutics. ‘Byworking closely with Philips MedicalSystems, we are incorporating theleading ultrasound technology andexpertise into the early stages ofproduct development, whichstrengthens our position as wemove further through our clinicaltrials.’

Anne LeGrand, senior vicepresident and general manager ofUltrasound, for Philips MedicalSystems, confirmed that Philipsrecognises the promise ofmicrobubble therapies.

The companies’ agreementincludes a mutual exclusivity clauseduring the term of the collaboration.Following completion of the researchprogramme, Philips and ImaRx willhave an exclusive negotiation periodto discuss future development andcommercialisation.

The ImaRx’ SonoLysis researchprogramme The company focuses on developingand commercialising therapies forstroke and other vascular disorders.

(Current commercialisationefforts are focused on itsproduct, Abbokinase as atreatment for acutemassive pulmonaryembolism).

The aim of this researchprogramme is to developproduct candidates thatinvolve the use of thefirm’s proprietary MRX-801microbubbles withultrasound to break upblood clots and restore

Microbubbles and ultrasound to treat ischemic stroke

12

PD-Q: A screening tool to identifyneuropathic components in pain patients

Every fifth

European is

suffering chronic

pain, according

to the recent

‘Pain in Europe

Survey’.

However, there

are pains and

other kinds of pain, as

particularly seen in patients

with neuropathic pain.

At the German Congress for

Orthopaedics and Trauma

Surgery new diagnostic and

treatment methods were

described that might promote

better pain therapy.

Usually doctors classify pain

according to an accepted

system that is based on the

type and extent of the

prevailing dysfunctions.

‘However, it is not the

dysfunctions but the underlying

pathophysiological mechanisms

the pain is based on which are

decisive,’ said neurologist and

psychologist Professor Thomas

R Tölle MD, who is Head of the

Pain Surgery at the

Neurological Clinic in Munich’s

Technical University. Pain, he

said, can be traced to

nociceptive and neuropathic

mechanisms. ‘Neuropathic pain

development, caused by

lesions or dysfunctions of

peripheral nerves or central

nerve tracts, takes a severe

course: Based on inflammatory

processes, the patients

develop physiological changes

that lead to hyper-sensitised,

peripheral, spinal and

supraspinal signal processing.

Patients with neuropathic pain

require specialist and

intensive treatment.’

At the DRK Pain Centre in

Mainz, neuropathic pain is

currently being documented

from comprehensive physical

examinations, laboratory

tests, electrodiagnostics,

imaging, biopsies and

quantitative sensory testing

(QST). Professor Hans-

Raimund Casser MD, the

Centre’s medical director,

said: ‘We have to intervene in

these inflammatory processes

as early as possible to prevent

nociceptor sprouting and

chronification of the pain. But

even achieving a precise

diagnosis is difficult and

complex, because we don’t

U L T R A S O U N D & R E S E A R C H

need to detect the symptoms

but the nerve damage.’

‘Up to now we have not had

any method to diagnose

neuropathic pain at an early

stage on a large scale,’ added

pain therapist Rainer

Freynhagen MD. With a

research associate and team at

the Anaesthesiology Clinic at

Düsseldorf University Hospital,

47,000 patients have been

examined in a project called

painDETECT. ‘We discovered

that patients with neuropathic

pain complain about long and

severe periods of pain with

relevant loss in functional

efficiency. Moreover,

characteristically they tend to

suffer from particularly

pronounced comorbidities, such

as sleep disorders, panic

attacks and anxiety or

depression.’

Based on the collected data

the researchers developed a

painDETECT questionnaire

(PD-Q) – a list of questions

that can be completed by

patients and their doctors

within a few minutes. ‘The

painDETECT questionnaire in

no way replaces regular

PAIN

Hall 9 Booth E31

Point-of-careultrasoundfrom SonoSite

At Medica, this year, SonoSite ispresenting innovations – M-Turboand the S-series – which presentnumerous technical improvementsand deliver a breakthrough imagequality, the company reports. ‘Withthe S-Series, SonoSite launches aradically new concept in ultrasoundunlike anything else in the market.

Dr RainerFreynhagen

tions. Thanks to a large capacity forimage and data transfer, the mobileultrasound systems provide many pos-sibilities for lower cost, multi-mediahospital communication. Therefore,it’s not just patients who benefit; hos-pitals are also experiencing benefitsdue to decreases in costs.’

Highlight is the S-Nerve visualisationtool, the first ultrasound device cus-tom-designed to support the specificneeds of anaesthesiologists who per-form regional anaesthesia,’ the manu-facturer explains. ‘The new SonoSiteproducts can perform a variety ofexaminations and deliver high qualitydiagnosis even under difficult condi-

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Study finds cartilage implant promisingFaced with meniscus injuries sur-geons usually decide to remove thetorn meniscal cartilage, which typicallyleaves the deficient knee vulnerableto future arthritis, because thepadding that provides shock absorp-tion and joint stability has beenremoved, causing bone to rub onbone.

A new knee-surgery device to helprepair ‘irreparable’ meniscus tearshas been approved by the FDA for usein humans. The BioDuct Meniscal Fix-ation Device was developed by HerbSchwartz, president and CEO ofSchwartz Biomedical, LLC, and JamesCook, MU professor of veterinary med-icine and surgery and William C. Allen,Endowed Scholar for OrthopaedicResearch in University of Missouri-Columbias’ College of Veterinary Med-icine, which they believe can save the

meniscus as well as long-term kneefunction.

The device transports blood andcells from the vascularised knee areato the avascular area of the meniscus,to enable healing.

The research team performed theBioDuct surgery on 25 canines – com-plete or partial repair of the meniscuswas observed in all cases thatreceived the BioDuct Meniscal FixationDevice.

Herb Shwartz pointed out that thisnew device could have a considerableimpact on orthopaedics because withfewer meniscal tear patients develop-ing arthritis there could be fewer totaljoint replacements, or a delay in theneed for one.

The study results have beenpublished in the American Journal ofSports Medicine.

Device helps heal the meniscusPoland – At September’s Interna-tional Cartilage Repair SocietyAnnual Meeting (ICRS), in War-saw, participants heard that aneocartilage implant called Neo-Cart, made by US firm Histogen-ics, is safe as well as promising.

NeoCart is an autogenous neo-cartilage implant grown by seed-ing a patient’s own cartilage cellson a collagen matrix. A patented,high-pressure tissue engineering

processor is said to produce morenatural neocartilage than other tech-niques.

Dennis Crawford MD PhD, Assis-tant Professor of orthopaedics andsurgical director for Sports Medicine& Cartilage Reconstruction at Ore-gon Health & Science University(OHSU), was reporting on an FDAPhase I safety trial that involvedseven patients treated with NeoCartat OHSU, with a 2-year follow-up. All

patients showed good cartilagefill and integration with sur-rounding cartilage. Knee jointfunction was improved in six ofthe seven patients. AdvancedMRI techniques showed thatthe NeoCart treatment hadresulted in the formation of truehyaline cartilage in four of theseven patients, Dr Crawfordpointed out. ‘This novel therapymay replace microfracture tobecome the next primary treat-ment for cartilage injury to theknee. Patients are getting painrelief for at least two years, thetechnology can be applied via asimple out-patient procedureand it appears by our best radi-ographic methods to matureand stabilise over time,’ headded.

13

c o m p a n y n e w sT H E R A P I E S

Children with re-cessive dystrophicepidermolysis bul-osa (RDEB) lack aprotein that bindsthe skin to the body,resulting in fragileskin that sloughs off

with little movement or friction. Inthe most severe cases, the skin alsosloughs off inside the body, affectingthe mouth, oesophagus and gastro-intestinal tract. EB is genetic andsevere forms are fatal. Those wholive to be young adults develop squa-mous cell carcinoma.

Now the first bone marrow andcord blood transplant to treat RDEBhas been carried out by physiciansat the University of Minnesota Chil-dren’s Hospital, Fairview, with thecollaboration of researchers atColumbia University, University ofMinnesota, on an 18-month-old boysuffering the most severe form ofRDEB.

With the help of an EB mousemodel the researchers corrected thedisease in mice using bone marrow.They tested various types of adultstem cells to determine which wouldpromote the development of type VIIcollagen — a protein that patientswith RDEB lack. One type of imma-ture cells from bone marrow provedthe best at producing binding fibrilsthat hold skin and body together.

This is the first approach to EBfrom a systemic perspective, usingtransplant as a method to rid thebody of the defective blood systemand replace it with a healthyblood system that produces type VIIcollagen.

The child received both umbilicalcord blood and bone marrow from aperfectly matched sibling. If theresults mimic the animal model, doc-tors anticipate the healthy blood sys-tem will aid in the skin’s ability toproduce type VII collagen necessaryto anchor the skin and lining cells ofthe gastrointestinal tract to thebody. Doctors anticipate in early2008 — approximately 100 days after

Infant receives first systemic therapy to treat RDEBtransplant – they will be able tojudge whether this treatmenthelped.

The paediatric BMT programmeat the University of MinnesotaChildren’s Hospital, Fairview, isinternationally recognised for pio-neering umbilical cord blood andbone marrow transplantation,including the world’s first success-ful BMT in 1968. In 2000, a teamled by John E Wagner MD, profes-sor of Paediatrics and director ofthe Division of Haematology,Oncology, and Blood and Marrow

Transplantation and director ofclinical research of the Stem CellInstitute, University of Minnesota,performed the first umbilical cordblood transplant from a siblingdonor ‘created’ after embryo selec-tion. The programme leads thenation in the use of umbilical cordblood in the treatment of adultsand children and in the develop-ment of innovative treatments ofvarious rare genetic diseases suchas adrenoleukodystrophy (ALD)and Fanconi anaemia.

Of this recent transplant, Profes-

Prof. John E.Wagner

diagnostic procedures, but it

is an important aid because

the calculated score has a high

significance as to the

prevalence of neuropathic

pain components,’ explained

Dr Freynhagen, who this year

was awarded the 1st

promotional prize for pain

research.

The questionnaire, which is

now available in fourteen

languages, paves the way for

early, individually adapted

medication. Good treatment

results are currently being

achieved with Pregabalin

(LYRICA, Pfizer). Licensed

since September 2006 for the

treatment of central

neuropathic pain, Pregabalin

modulates a calcium influx

into the nerve cell and leads

to a reduced release of

excitatory transmitters. It not

only weakens the course of

the pain and its intensity but

also eases mental and somatic

symptoms, such as sleep

disorders and anxiety. ‘I admit

that we do not yet know all of

the pathomechanisms. But we

are getting very close with our

methods and have achieved

significant therapeutic

success,’ Prof. Tölle

concluded.

sor Wagner said: ‘Our goal is todetermine the usefulness of stemcells, whether from the umbilicalcord blood or adult tissues likebone marrow, in the treatment ofhuman disease. Hundreds of thou-sands of children and adults arewaiting for new breakthroughs instem cell research, and time isnever enough. In two years, theteam was able to move this pro-ject forward remarkably fast —from testing in animal models totreating patients. Time will tellwhether this risky treatment will

work as effectively in humans. But,RDEB is a horribly debilitating, life-threatening disease with no existingcurative therapy.’

Maria Hordinsky MD, head of theDepartment of Dermatology at the Uni-versity of Minnesota and a member ofthe care team, added: ‘This representsa real change in thinking within thedermatological community. The possi-bility of this approach compels us toexplore more broadly the way someskin diseases are typically treated.’Source: Molly Portz, University of

Minnesota

DERMATOLOGY

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H E A L T H C A R E M A N A G E M E N T

MEDICAL TOURISMOphthalmology

UK-based company StatMedica specialises in medical tourism in Polandand has been appointed to represent several leading Polish eye surgeonswho operate in high-tech clinics in major cities across that country,reports Alison Hope, the firm’s Managing Partner in London. Clinicsrepresented by the firm offer a wide range of elective procedures,including refractive surgery, cataract removal and corneal transplants. The StatMedica team assists with communications between patient andclinic and arranges an in-depth consultation with the opthalmologist priorto a patient’s departure from the UK to Poland, Alison Hope adds.Warsaw-based managing partner, Lukasz Lies, leads the Polish team,which provides a range of services, from airport transfers to 24-hour careby a qualified professional. * Source, StatMedica Research

The increased need of medicalcare among ageing populationsis causing cost explosionsacross Europe. Some countries

tackle this challenge with ManagedCare processes: Controlled inter-ventions in the healthcare systemaimed at getting doctors, patientsand insurers to follow a more bal-anced, forward-looking path. Usingdifferent control models, theNetherlands and Switzerland haveshown that it is possible to achievesignificant cost savings without anyloss of the quality of care.

Competition, bonuses and competentpatients secure the future‘Fewer and fewer workers mustcare for increasing numbers ofpatients. Our system is on the brinkof collapse – something has to hap-

Top down or bottom up?Managed Care in the Netherlands and Switzerland

save money,’ Prof. Caris explained.Therefore, the Netherlands addi-tionally implemented a reimburse-ment system whereby patients whoonly had basic medical care fromtheir GPs were reimbursed contri-butions of up to 255 Euros. Patientscan also make additional savings ifthey join group contracts or agreeto take on part of any treatmentcosts, if and when they arise:‘These simple measures haveproved to be very effective. Peoplenow get more involved in savingmoney and develop more realisticexpectations’ the professor pointedout. ‘Too much control and regi-mentation, on the other hand, isbad for the healthcare system.’According to this expert, action isalso needed from the doctors: Effi-cient treatment is based on three

Prof. Caris cites as a positiveexample the treatment of childrenwith attention deficit hyperactivitydisorder (ADHD). Here the combi-nation of medication, supportivefamily therapy and the strengthen-ing of their own competence forthose affected, by, for example,making their daily routines morestructured, is having the maximumeffect. ‘Better quality at lower costs:To achieve this goal, patients andhealthcare professionals should beready for the market,’ Prof. Carisconcluded.

Control of medical treatment andquality assurance is down to the GPThe introduction by law of Man-aged Care in Switzerland occurredas far back as 1996. Other than inThe Netherlands, the system is not

Peter Berchtold MD Professor Jo Caristhings: Specific medical therapy,referral to supportive social institu-tions and enhancing patients’ healthcompetence. ‘We tend to start large-scale campaigns that point out topeople that their lifestyles are dam-aging and which actively encouragethem to stop smoking. But, whenpeople are actually ill, we onlyinvolve them in their own treatmentin a more passive manner. Thepatient is therefore put under tute-lage. He feels left alone, is scaredand lacks the competence to helphimself when he is ill. We have togive patients more and better infor-mation about their illnesses andincrease their ability to act. Compe-tent patients can make significantcontributions towards avoidingunnecessary costs.’

pen,’ said Professor Jo Caris of theTIAS Business School in Tilburg,the Netherlands, during the BMCCongress ‘Managed Care in

Europe’.In January 2006, the Netherlands

introduced a new medical insur-ance law in January 2006 thatmoved the system away from theprinciple of comprehensive solidar-ity and closer to a system based oncompetition, self-regulation andchoice: Every adult Dutch citizentakes out a basic insurance servicespackage, regulated by the state,with a private medical insurer,which is independent of incomeand currently set at 1,050 Euros ayear. In addition, contributions of6.5%, which are dependent onincome, have to be made, most ofwhich are covered by employersand form the basis of the risk struc-ture compensation scheme. ‘Chang-ing the financing system in itselfdoes not prevent the uncontrollableconsumption of medical servicesthough. We had to emphasise topatients that medical care costsmoney and give them incentives to

regulated top-down, but bottom-up,with the legislator almost completelypassing on the responsibility for effi-cient and cost-effective medical carefor the population to general practi-tioners (GPs). This system is basedon so-called medical networks –around 56% of doctors have so fardecided on interdisciplinary co-oper-ation within an integrative network.‘Within the medical network, the GPas the gatekeeper is the central pointof contact for patients. In case of ill-ness, people are always initially seenby their GPs. The GP controls med-ical services and, if required, referspatients to specialists within his net-work. Through the co-ordinated con-trol by one person therapy turns outefficient and cost-effective andduplicate examinations can beavoided,’ said Dr Peter Berchtold, ofForum Managed Care, Switzerland.‘Compared with traditional care, thecost saving lies at between 10% and35%,’ he continued. ‘Doctors whohave become part of these networksshow a lot of their own initiative.They are not only interested in cut-ting costs but also in quality assur-ance. There have been particularimprovements in information trans-fer. A computer network that docu-ments all therapeutic measures inelectronic form and is accessible foreveryone involved in treatment, wasalso set up alongside the medicalnetworks over the last few years.Patient safety has increased signifi-cantly.’

More quality and more safety – thenew system also appeals to patients,particularly as it is worthwhile finan-cially. About 30% of all those withmedical insurance decided on treat-ment within a particularly medicalnetwork and therefore receivedbonuses of up to 20%. Regular contri-butions can also be lowered ifpatients agree to take on a highershare of costs, if and when theyarise. ‘The system of differentiated,additional contributions is very pop-ular in Switzerland, he said. ‘Manypatients also use the telephoneadvice services that have recentlybeen introduced. These providecompetent information before costseven arise.’

So far the managed care measuresimplemented have been mainlyrestricted to out-patient care andless so to inpatient services. Hospi-tals, rehabilitation clinics and out-patient care services should followsuit, Dr Berchtold believes. ‘Co-oper-ation and networks are becomingincreasingly important as health isalways an interdisciplinary matter.Those who don’t co-operate will notsurvive within the healthcare marketof the future’

The European Commission (EC)has postponed the EU Directivethat would have affected the use ofMRI until 30 April 2012, to allowtime for a substantive amendmentto be adopted. The Alliance forMRI said it welcomes the Commis-sion’s statement that ‘… the futureamendment will aim to ensure thatlimits will not have an adverseeffect on the practice of MRI’ andthe recommendation to MemberStates to put the transposition ofthe current Directive on hold.

‘MRI is a powerful, non-invasiveand safe diagnostic and researchtool,’ said Professor GabrielKrestin, Professor of Radiology atErasmus MC, University MedicalCentre Rotterdam, in the Nether-lands, and a leading member of theAlliance for MRI. ‘However, itsapplication often relies crucially onthe presence of a healthcare work-er or researcher. If the EC legisla-tion were implemented, it wouldalmost certainly impact on patientwelfare and be a major setback forscientific research, denyingpatients innovative treatments inthe future.’

In June 2007, the Alliance forMRI held a lunch at the EuropeanParliament with CommissionerSpidla to discuss research under-taken by Professor Stuart Crozierof Brisbane University, Australia*that vindicated the Alliance’s con-cerns.

In addition to its serious impacton healthcare, the Alliance believesthe Directive would threatenEurope’s position as world leaderin MRI research, as recognised inthe Nobel Prize awarded to SirPeter Mansfield. MRI is a leadingexample of where the EU stands incutting edge research.

‘We look forward to workingwith the European Commissionprior to the proposal to amend thedirective,’ Professor Krestin said.‘It is essential that the EuropeanCommission assesses closely thefull impact the directive will have,taking into consideration thesocial, economic and environmen-tal impact of the legislation. Anynew legislation must be evidence-

15

N E W S

The DCA Vantage Analyser from Siemens Medical Solutions Diagnostics is auser-friendly, point-of-care (POC) patient management platform for diabetes. Itprovides glycosylated haemoglobin (HbA1c), microalbumin/creatinine andalbumin-to-creatinine tests. Physicians can enter a patient ID, via the touchscreen or barcode, view on-board printed reports and graphs of HbA1c trends.

The system is network-ready. Test results can be shared within the office,clinic, among coordinated POC or can be easily uploaded to an externalhealthcare information technology (HIT) system.

Besides glycaemic control the microalbumin/creatinine measuring capabili-ty of DCA Vantage helps physicians by early detection of kidney disease, acommon complication of diabetes. The onboard glomerular filtration rate(GFR) calculator assists in kidney disease staging.

POC diabetesmanagementMRI and magnetic fields

EU Directive postponed for amendment

Magnetic Resonance Imaging (MRI) scans pro-duce detailed pictures of the inner structure andfunction of patients’ bodies using magneticfields and radio waves. Its use has become anessential tool in diagnosing and treating illness-es such as cancer, cardiac diseases and neuro-logical problems, and in medical research forthe same disorders.

The EU Physical Agents Directive 2004/40/EC (EMF), however, would prevent medicalstaff from assisting or caring for patients duringMRI imaging, due to concern over the effects ofthe magnetic fields generated.

The Alliance for MRI, which represents acoalition of European Parliamentarians, patientgroups, leading European scientists and themedical community, has campaigned to bringattention to the potential loss to patients.

‘The increase in cancer survival seen overthe past decades is, to a large extent, due tomore precise diagnostic tools - MRI included,’said Professor Dag Rune Olsen, Chairman ofESTRO Physics Committee. ‘Impeding themedical use of MRI would have severe impacton treatment out-come of cancer patients inEurope. The European Commission must learnfrom their experience with this Directive andconsult widely before implementing Directivesthat impact negatively on research and patientcare.’

based and founded on sound sci-ence. There has been no provenharmful effect of MRI to eitherpatients or workers over the past25 years, during which time over500 million examinations havebeen undertaken.’ The Alliance forMRI believes that it is essential toevaluate the real risk to patientswhich would be brought about byimpeding the full use of MRI,

against the notional and unprovenrisk to workers.

The safety of MRI workers isalready regulated by the EU Med-ical Devices Directive (amend.Direct 93/42/EEC) and the estab-lished MR safety standard IEC/EN60601-2-33 (as amended to includeusers/workers). The IEC standardestablishes limit values for time-varying electromagnetic fieldswhich have been set, so that anydanger to patients and workers isexcluded.

* Study Commissioned by the UK

Health and Safety Executive

http://www.hse.gov.uk/research/rrpdf/

rr570.pdf

16

C O M P O N E N T S & M A T E R I A L S

Britain’s biggesttrade fair formedical productdesign andmanufacturingwill be held nextFebruary in theNEC Birmingham

Exhibitors will present contract manufacturing& subcontracting, component fabrication,tubing, adhesives & adhesive products,electronic components, production/assembly,packaging equipment and materials, motors &motion control, plastics, testing equipment &services, hardware & IV components,precision metalworking, tooling andmachining, for use by medical device andequipment manufacturers.

3C 2008 - the Contamination Control andCleanroom Products exhibition, focuses onproducts for the protection and preventionof particle infection to personnel, products,or the environment. Sections includedesign and construction products andservices, garments and consumables,equipment and products and generalservices.Details: www.devicelink.com/expo/mdt2007/

High-tech solutionsfor medicaltechnology

Micro and medical technologyare growing together anddriving one another on to newdevelopments. According to a

survey by IVAM, the ProfessionalAssociation for Microtechnology(Dortmund), medical technology isthe principal target sector forEuropean microtechnologycompanies, with a clear lead on thetelecommunication and electronicindustries. Over 43% of thecompanies questioned replied thatthey regard medical applications asthe primary focus of their marketingopportunities. It is therefore nowonder the international fairCOMPAMED, for internationalsuppliers in medical manufacturing,continues to boom alongsideMEDICA. Again, in 2007, this eventhas seen impressive growth.

‘Three months before the start ofthe COMPAMED 2007 tradeshow,the number of exhibitor applicationsreceived was over 40% higher than in2006, and there was an increase of48% in terms of the surface areareserved,’ said Wilhelm

Niedergöker, General Manager ofMesse Düsseldorf. There are over455 exhibitors from 30 countries anda surface area covering over 8,400min Halls 8a and 8b.

Among the exhibitors isNanoFocus AG (Oberhausen), whichis showing its non-destructive,automatable 3-D measuring systems,designed to enable surfaceinspection of implants or stents,among other things. Heinz-Peter

Hippler, the company’s SalesManager said: ‘With regard to ourmeasuring technology, which rangesfrom the microscale to thenanoscale, we are expecting a surgein demand from the field ofbiomedical engineering. Accordingly,we are expecting great things fromthis event.’

In the Innovation Report 2007, anannual publication by theAssociation for Electrical, Electronic& Information Technologies (VDE,Frankfurt a.M.), medical technologyremains the third most importantdriver of innovation. Europeans leadthis field, well in advance of theUSA, according to this event’sorganisers. ‘With over 70% of thetechnical experts, Germany andEurope can claim to have the highestinnovative capacity in medicaltechnology; by comparison, the USAhas 24%. They are followed at somedistance by Japan and China. Alsonoteworthy is the forecast for 2015,according to which not only will the

UK

13-14 FebruaryUnited Kingdom2008

17

C O M P O N E N T S & M A T E R I A L S

COMPAMED 2007order of rank stay the same, eventhe percentage shares are to remainlargely unmodified.’

The study of ‘Opticaltechnologies – CommercialImportance in Germany’,commissioned by the BMBF,reports that the global market formedical technology and lifesciences has a volume of €18.6billion. This amount is supposed toincrease to €38.8 billion by 2015,which represents a growth rate of7.6%. Germany’s share of thisamounts to almost 16%. It is worthmentioning the high percentage ofgraduates (13%) among the 17,400employees of the medicalengineering industry, whichexports 70% of its products abroad.The trends toward intelligent and

multifunctional high-tech productsand toward continualinternationalisation are also acharacteristic of COMPAMED.

Top potential for optical inspectionsystemsSimilar to NanoFocus AG, theOptical Solutions division of Siemensis also working in the area of qualityinspection, for which it offers ultra-fast optical inspection systems.These can detect, for example,fractures in stents and therebyprevent micro-wounds in arteries,which can occur when parts ofdamaged stents straighten up in theartery. Markus Lotz from SiemensOptical Solutions sees a bright futurefor measuring and image processingtechnology, ‘The developmentpotential of optical inspectionsystems can be increased fivefold,because we have not yet availed ofall the opportunities presented byimage processing.’

The measurement of surfacetextures — down to the nanoscale —would be inconceivable withoutmodern sensors. This topic thereforestands equally high on the prioritylists of the exhibitors and the visitorsto COMPAMED. The components,based on CMOS technologies(Complementary Metal-OxideSemiconductor), for example, andtherefore belonging to the micro-technology sector, are also used tomeasure the flow rate of gases andliquids in anaesthesia systems andinfusion technology, among otherthings. However, Ulf Kanne, ProductManager at Sensirion AG in Stäfa inSwitzerland, can envisage numerousother application areas – especiallyfor disposable sensor solutions:

‘Humidity sensors integrated inplasters could make it easy tomonitor the healing process of burninjuries, for instance.’

Laser-modified surface propertiesThe on-going miniaturisation inmany branches of the medicalengineering sector also demandsnew manufacturing techniques. Atthis year’s event, the HannoverLaser Centre (LZH) is offering a

whole batch of micro-technicalmanufacturing processes formedical product engineering. Alongwith conventional precisionmethods, such as laser removal,cutting and joining, other productmodifications and solutions arebeing presented that specificallytarget medical applications. Forexample, laser processes can beused to make selectivemodifications to surface properties

– especially of polymer materials. Inthis way, through the use of micro-stereolithography, materials can beprovided with particular liquidproperties.

‘Micro-fluid systems are comingincreasingly to the fore in medicaltechnology. Systems like theserequire new types of expertise,above all in manufacturingtechnology,’ said Dr Roland

Stangl, Director of MicroTechnologies at PARI PharmaGmbH. PARItec GmbH, which ispresenting current developments inthis field. The firm’s micro-technologies, using the example ofPARI eFlow the innovative medicalcontinued on page 18

Messe Dusseldorf, the massivetrade fair centre, filled annuallyby MEDICA and COMPAMED

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18

C O M P O N E N T S & M A T E R I A L S

nebuliser, are being demonstrated.The production of PARI eFlowincorporated medicine-compatibleand autoclavable adhesive bondswith various materials such assteel, piezo-ceramics and plasticsand involved high-speed laserdrilling in steel, for holes with adiameter of two micrometers ormore. The company also providesthis technique as a service.

Two important elements in fluidsystems of whatever size arepumps and valves. BartelsMikrotechnik GmbH is presentingthe ‘mp6’, its latest micro pumpgeneration, for the first time, at the

continued from page 17 IVAM Joint Pavilion. Equippedwith a double actuator (actuator= final controlling element in acontrol loop), the componentdoubles the back pressure rangeto 500 mbar, while a modifiedsignal form ensures low-noiseoperation. A valve with positiveopening pressure, for regulatingflow when the pump is not inoperation, is currently beingdeveloped to go with the pump.‘The basic principle of the piezomembrane pump has been keptsimple so that it can be adaptedto various requirements – thecustomer decides whether heneeds, for example, a larger

volume range, compatibility with aparticular material or greaterconveyor accuracy,’ explainedProduct Manager Severin Dahms.Bartels is presenting somespecimens of the implementation ofsuch requirements at the trade fair.The prototypes of a high-pressure, ahigh-volume and a regulated micro-pump will illustrate the numerouspossibilities. Complicatedcomponents like these can beapplied, for example, in laboratorytechnology in bio-chips (‘lab-on-chip’ applications).

Many MEDICA exhibitors migrate toCOMPAMEDMany of MEDICA’s ‘traditional’exhibitors are exhibiting atCOMPAMED this year for the firsttime. Along with companies such asAlike Buerkert, Binder, Degussa,Helbling and others, these includeBernd Richter GmbH (Wipperfurth)and Nicolay GmbH (Nagold), whichboth offer cable systems andaccessories for medical technology.

Mechatronic AG (Darmstadt),which manufactures programmableelectronic medical devices, as wellas the corresponding components,modules and software, haveswitched to COMPAMED for thefirst time. ‘MEDICA has played adecisive role in the success of ourcompany up to now,’ explainedThomas Ullmann, Chief Executive

Officer of Mechatronic AG. ‘Not leastdue to the valuable contacts that weestablish every year at the trade fair,our turnover has increased almostfivefold in the last ten years. At thesame time, almost 90% of theMEDICA visitors were outside ourcore target audience. As a result ofswitching to COMPAMED, we areanticipating a significantly sharperfocus on our specialised audiencefrom the decision making bodies fornew developments in medicaltechnology.’

Quite apart from the everincreasing number of exhibitors thatare presenting innovations andproducts from the entire field ofmedical technology, the ‘High-tech

for Medical Devices’ forum providesa different information focus.Organised by IVAM, it shows thelatest trends, particularly regardingmicro and nanotechnology for usein medicine. New materials andsubstances, a traditional mainstayat COMPAMED, is again the centreof attention.

Of the 137,503 professionals whoattended last year’s overall event,i.e. MEDICA and COMPAMED,about 13,000 experts wereinterested in the technicallyspecialist range of products offeredat COMPAMED.Report by Klaus Jopp, freelance

technical writer for science and

technology, Hamburg.

IVAM is an international associationof companies and institutes that spe-cialise in microtechnology, nanotech-nology and advanced materials. This13-year-old association aims toopen up new markets and set stan-dards with its 242 members from 17countries.

According to its latest survey, med-ical technology is top of the rankinglist of the European MEMS industry’smost important target markets.

26 of the association’s membersare exhibiting at this year’s COM-PAMED.

Sensor technologySensirion is demonstrating the useof gas and liquid flow sensors in spe-

THE IVAMcific medical applications (e.g.anaesthesia, ICU, homecare ventila-tion, CPAP, medical diagnostics,analytics and drug delivery). Forexample, it is illustrating the use ofits gas flow sensors in medical ven-tilation applications, and is dis-cussing future sensor-based prod-ucts that become possible thanksto its CMOSens technologye.g. implantable and disposablesolutions.

Aceos GmbH is exhibiting threenovelties: two new O2 sensors:ACE-Xmed2 with an ultra-fastresponse time (< 50ms), especiallyapplied with respiratory applicationsfor infants, and ACE-Xmed3 with ameasuring range up to 60 Vol%O2for patient monitoring; also, theACE-DXmed1 – a plug&play sensormodule to measure O2 and CO2in spiroergometric applicationssimultaneously.

Tiny componentsThe Servometer Precision Manufac-turing Group, LLC, is presenting cus-tom electroforms, which are very pre-cise, thin-walled, light weight preci-sion components, that can be madeas miniscule as 0.020î in diameter,with walls as thin as 0.005î, madeof nickel, copper, implantable gold,silver, or a combination thereof,depending on application require-ments. Servometer electroforms canbe used as molds, precision tubing,precision nozzles and other light-weight, structurally rigid componentsin various applications, includingboth invasive and non-invasive appli-cations within the medical industry.

Smart Products, Inc. is introducing

its 101 Barbed Check Valve at theIVAM joint pavilion, which fits 1/8î IDtubing and is ideal for medical applica-tions including blood pressure cuffs,kidney dialysis, post-surgery instrumen-tation, or any application where spaceis limited. Due to a spring-loadeddesign, the 101 plastic valve does notrequire pressure to close and can alsobe used as a pressure relief valve. Arange of precise opening pressuresfrom 2 PSI to 20 PSI are available.Also new is the 103 NPT Check Valvewhich mounts by screwing into a mani-fold. The thread size is 1/8î, and achoice of materials and opening pres-sures is available. Smart Products pro-vides over three million possible checkvalve combinations with a modular,mix-and-match capability.

MeasurementLasers for oxygen detection are beingexhibited by eagleyard PhotonicsGmbH. The company has expanded itsproduct portfolio by 760 nm and 763nm Distributed Feedback (DFB) lasersin butterfly package. eagleyard’s newDFB lasers track down oxygen by thecharacteristic ‘fingerprint’ of theabsorption spectrum. With narrow linewidth, the lasers can sense even resid-ual amounts of oxygen, the firmreports. A mode-hop free emissionguarantees a very precise gas analysisby means of absorption spectroscopy.The lasers are designed for applica-tions in the medical, pharmaceuticaland chemical industries.

Bonding technologyAs a system supplier, PARItec GmbH ispresenting micro technologies exempli-fied by the novel drug nebuliser PARIeFlow. This includes bonding technolo-gy with different materials such assteel, piezo ceramics, and plastics(e.g. polyimide) for medical use, aswell as autoclavable or high-speedlaser drilling for holes ex 2 µm diame-ter. ‘Micro fluidic systems are moreand more common in medical technolo-gy. Such systems require new compe-tences particularly in manufacturingtechnology,’ said Dr Roland Stangl,Director Microtechnologies of PARIPharma GmbH.

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19

Meet our team at MEDICA! EH@MEDICA – Here we are again, at the greatest medical show on earth.As the official show publication, EH@MEDICA has been produced in threeseparate issues by our flagship magazine EUROPEAN HOSPITAL (EH). Eachissue is packed with technological and medical innovations as well as newsof medical and healthcare advances. • On Wednesday the issue focuses on ultrasound• In the Thursday issue we present progress in hospital IT systems• Friday’s focus is on news surgical procedures and equipmentThe European Hospital team is at the fair (hall 7, booth E15), all lookingforward to meeting you, to hand out free issues if you missed any, and toanswer your queries regarding editorials or advertising. Our reporters arealso circulating around MEDICA to catch the most interesting highlights ofthe fair and report about these. Their on-the-spot reports will appear, for thefirst time, on our homepage www.european-hospital.com in a specialMEDICA section. So, even if you must miss the fair, you can access dailynews to keep up-to-date.

In addition, because the world-wide-web and e-mail communications have

And collect your FREE copies of ourmedical and healthcare publications increased in importance, European Hospital islaunching a new, online newsletter, so you canreceive selected medical news directly in your own e-address! (For subscription details, please visit ourwebsite!)

Along with our main medical and healthcarepublications and related activities, European Hospitalis again organising the Hospital Manager Symposium2008, in tandem with the European Congress ofRadiology (ECR). In 2007, the Symposium attractedover 300 radiologists to hear talks and lectures givenby our selected international experts in Finance, ITand Management.

Also, at this year’s ECR, we launched our latestpublication: The RADBOOK, the first guide forradiology equipment in the English language. EH willcontinue the successful publication of this valuable

source of information for those who mustmake decisions on purchasing new systemsfor their hospitals and clinics.

We have also expanded our pan-Europeanreadership to Russia, by publishing, withinour prestigious journal European Hospital,several special issues, as well as additionalpages in the Russian language – a greatsuccess. In addition, we will publish, for thefirst time, a special issue for the mostimportant Russian medical fair – Zdravo(Zdravookhraneniye 2007). EH special publications in 2007Special supplements:Mammography. Surgery.Plus: EH@ECR, EH@ ESC,EH@Moscow Medical FairEH fair activitiesEurope: MEDICA and the ECR USA: The RSNA, in Chicago.

Hall 7 Booth E15

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: info@european-hospital.com

Editor-in-Chief Brenda MarshArt Director Mary PargeterExecutive Directors Daniela Zimmermann,

Reiner HoffmannInternational Media Consultant Gabriela EriksenManaging Editor Denise HennigEditor Meike LernerProduction & Distribution: Janka HoppeRussian Supplement Sergey Bezrukov,

Fibrotex GmbH, Fischerstr. 140477 DüsseldorfTel: +49 211 550 49 70, Fax: +49 211 550 49 710e-mail: fibrotex@gmx.net

Founded by Heinz-Jürgen WitzkeCorrespondentsAustria: Christian Pruszinsky. Baltic: Andrius Vagoras.Czech Republic: Rostislav Kuklik. France: JaneMcDougall, Keith Halson. Germany: Anja Behringer,Annette Bus, Guido Gebhardt, Heidi Heinhold, Max Hey-mann, Holger Zorn. Great Britain: Brenda Marsh, IanMason. Italy: Danilo Camisasca. The Netherlands, Bel-gium: Michiel Bloemendaal. Poland: Pjotr Szoblik. Spain:Eduardo de la Sota. USA: Karen M Dente, Cynthia E Keen,Ivan Oransky, Craig Webb.UK editorial address55 Wey Meadows,Weybridge, Surrey KT13 8XYSubscriptionsJanka Hoppe, European Hospital,Theodor-Althoff-Str. 39, 45133 Essen, GermanySubscription rate6 issues: 42 Euro, single copy: 7 Euro. Send order andcheque to: European Hospital Subscription DeptFinishing media technique jöhri,

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RepresentativesGermany, Head OfficeEuropean Hospital, Theodor-Althoff-Str. 39,45133 Essen, GermanyTel: +49 201 87 126 851-852, Fax: +49 201 87 126 864e-mail: dz@european-hospital.com

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: gh@european-hospital.comGB, Scandinavia, BeNeLux, FranceSimon Kramer, Willem Alexander Plantsoen 25,2991 NA BarendrechtTel:/Fax +31 180 6200 20e-mail: sk@european-hospital.comIsraelInternational 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: hw@european-hospial.comJapanEcho 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: ta@european-hospital.comSouth 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: ch@european-hospital.comTaiwanJurassic 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: bc@european-hospital.comUSA & CanadaMedia International, Hanna Politis, 8508 PlumCreek Drive, Gaitherburg, MD 20882, USATel: +1 301 8696 610, Fax: +1 301 8696 611email: hp@european-hospital.com

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