Abstract: A system for detecting/quantifying the conductance of a right-to-left cardiac shunt includes a mouthpiece assembly, a solenoid-driven vacuum/pressurization assembly; a controller for operating the solenoid-driven vacuum/pressurization assembly; and a monitor for displaying the instructions from the controller. A microbubble counting cell and digital image sensor are combined with software-based image analysis to determine a number of microbubbles contained in a microbubble counting zone. A monitor enables operator specification of total volume of contrast agent to be injected into the patient. One or more first Doppler ultrasound transducer arrays are positioned adjacent to targeted intracranial arteries at one side of the skull or a pair of first Doppler ultrasound transducer arrays positioned adjacent to targeted intracranial arteries at both sides of the skull.

Abstract: A system for detecting/quantifying the conductance of a right-to-left cardiac shunt includes a mouthpiece assembly, a solenoid-driven vacuum/pressurization assembly; a controller for operating the solenoid-driven vacuum/pressurization assembly; and a monitor for displaying the instructions from the controller. A microbubble counting cell and digital image sensor are combined with software-based image analysis to determine a number of microbubbles contained in a microbubble counting zone. A monitor enables operator specification of total volume of contrast agent to be injected into the patient. One or more first Doppler ultrasound transducer arrays are positioned adjacent to targeted intracranial arteries at one side of the skull or a pair of first Doppler ultrasound transducer arrays positioned adjacent to targeted intracranial arteries at both sides of the skull.

Abstract: A system, and apparatus for detecting and quantifying circulatory anomalies, including right-to-left cardiac shunts. The apparatus implements a sensor system useful in connection with a circulatory indicator delivery system. The sensor apparatus is preferably configured with a series of emitter/detector pairs to optimize the sensitivity of detection of the circulating indicator. Sensing of the indicator concentration takes place at an arterial vasculature, for example, the pinna of the human ear. A monitor/controller calculates and displays a indicator/dye dilution curve to assess for the presence of a cardiac shunt. The monitor/controller further corrects the indicator/dilution curve displayed for any recirculation phenomena and can quantify any right-to-left shunt calculated conductance associated with detected shunts.

Abstract: Methods, apparatus and systems for precisely controlling a Valsalva maneuver and the timing thereof in conjunction with testing a patient for a cardiac shunt, and for ensuring that a patient performing a Valsalva maneuver creates a required pressure using their diaphragm. Embodiments of a Valsalva maneuver mouthpiece assembly are also disclosed for use with the invention methods, apparatus and systems. The mouthpiece assembly is adapted to selectively operate between a state that produces resistance to the exhalation pressure of a patient into the mouthpiece and a state wherein the pressure resistance is rapidly removed so as to cause an involuntary exhalation of the air in the patient's lungs at a time of desired Valsalva maneuver release.

Abstract: Systems and methods for detecting circulatory anomalies such as, for example, right-to-left cardiac and pulmonary shunts. A fluorescing indicator is injected into the bloodstream of a subject. An optical sensor is used to transcutaneously excite the indicator into fluorescence and to transcutaneously detect the fluorescence, and a relative concentration of the indicator is determined as a function of time. An indicator dilution curve is generated from the relative concentration readings, the curve shape is analyzed for the indication of a shunt and, if a shunt is detected, a ratiometric area under the curve analysis is performed and combined with a calculated cardiac output value to provide a shunt conductance value. A Valsalva maneuver may be performed as a part of the method. System embodiments may include a controller/monitor that monitors, times, cues and/or analyzes various steps of a shunt detection test.

Abstract: A system, method and apparatus are disclosed for using a transcutaneous detection system to measure the quantity of a circulating organ activity detection analyte in the blood, and thereby assay the activity of an organ. A preferred organ for assay is the human liver and a preferred indicator is indocyanine green (ICG) dye The procedure is under the control of a monitor/controller having a visual display and capable of providing cues to the operator. A sensor array apparatus for use in conjunction with the system monitor/controller is configured for increased sensitivity of assaying organ function.

Abstract: The invention generally relates to a system, method and apparatus for detection of circulatory anomalies in the mammalian body. Particularly, apparatus is provided that allows the clinician to quantitatively determine the extent of any anomalies in the pulmonary circulation. Specifically a quantifiable agent is injected into a peripheral location, and the transit of the indicator agent is monitored. Aberrant circulation is them quantified. The preferred indicator is an injection of indocyanine green dye, detected and measured by fluorescence at a sensor location, for example, at the human ear. Quantification is carried out by using cardiac output procedures and alternatively, the use of Valsalva Maneuver is monitored at a monitor/controller providing visual cues to the patient and operator.

Abstract: Implant apparatus and method for effecting a controlled heating of tissue within the region of dermis of skin. The heater implants are configured with a thermally insulative generally flat support functioning as a thermal barrier. One surface of this thermal barrier carries one or more polymerically encapsulated heater resistor segments with a lead assemblage exhibiting a 4-point topology. Each of the encapsulated heater segments may be thermally associated with a metal thermal spreader dimensioned in correspondence with and aligned with the heater segments. The implants are located within heating channels at the interface between skin dermis and the next adjacent subcutaneous tissue layer such that the heat spreaders are contactable with the lower region of dermis. During therapy a conformal heat sink is positioned against the skin above the implants and a slight tamponade is applied through the heat sink to assure a proper form of conduction heat transfer.

Abstract: The preferred indicator is an injection of indocyanine green dye which is detected and quantified by causing it to fluoresce at a sensor location, for example, at the human ear. Quantification is carried out by using cardiac output procedures and where called for, the Valsalva Maneuver is monitored at a monitor/controller giving visual cues to the patient and operator as to the quality of the necessary exhalation pressure maintenance.

Abstract: A target tissue volume is accessed with a cannular instrument, the tip surface of which supports a precursor electrode assemblage which is electrosurgically excitable. The instrument tip initially is inserted through an incision made in the skin of a patient utilizing a pair of retractor components, the tips of which are located at a proper depth for positioning the precursor electrodes of the recovery instrument. The retractor components also are configured to define a guidance channel for receiving the tip of the recovery instrument. By stabilizing the instrument when the precursor electrodes are adjacent the tips of the retractor components and then slidably removing the retractor apparatus along the surface of the instrument, the tissue is “set” to assure proper precursor electrode positioning.

Abstract: Method, system and apparatus for carrying out accurate electrosurgical cutting. A thin resilient electrode is utilized at the forward end region of an instrument that is deployable from a longitudinally disposed slot positioned rearwardly of the tip of the instrument. Lateral sides of the slot extend between a forward location adjacent the tip and a rearward location. The electrode is deployed by urging it forwardly in compression to form an arch profile supported by the abutting slot sides adjacent the forward and rearward locations. Electrosurgically excitable with a cutting output, the electrode may carry out a cutting action both during its deployment and retraction into the noted slot. This permits a pivoting maneuver effective for circumscribing a volume of targeted tissue.

Abstract: Electrosurgical tissue specimen recovery apparatus and system employing a multi-leaf capture component configured with pursing cables which are electrosurgically excited to define a cutting leading edge. To complete a capture, the cables are loaded in tension to purse and thus converge the tips of the capture component leafs together. The forward regions of the leafs are configured with a combination of a thin flat stainless steel region over which a polymeric cable guide is positioned. The polymeric cable guide and stainless steel leaf driving combination improves frictional aspects as well as the resulting aspect ratio of a recovered tissue specimen.

Abstract: Method for effecting a controlled heating of tissue within the region of dermis which employs heater implants which are configured with a thermally insulative generally flat support functioning as a thermal barrier. From the surface of this thermal barrier are supported one or more electrodes within a radiofrequency excitable circuit as well as an associated temperature sensing circuit. A model of R.F. current path flow is developed resulting in a current path index permitting a prediction of current path flow. Improved electrode excitation is developed with an intermittent R.F. excitation of electrodes shortening therapy time and improving skin protection against thermal trauma.

Abstract: Method, system and apparatus for carrying out a controlled heating of tissue in the region of skin dermis. A quasi-bipolar arrangement of wands or implants carrying multi-segmented active electrodes, temperature sensing and wand location LEDs as combined with a return electrode and heat sink function. Radiofrequency energization of the active electrodes is carried out in a ramping-up and pulsing fashion to provide relatively short therapy intervals. The combined return electrode and heat sink components may incorporate photo-detectors, which perform to insure proper alignment with the LED carrying active electrode sequences. An isotonic saline solution is located intermediate the contact surface of the combined return electrode and heat sink and the surface of skin over implanted active electrodes.

Abstract: Implant apparatus and method for effecting a controlled heating of tissue within the region of dermis of skin. The heater implants are configured with a thermally insulative generally flat support functioning as a thermal barrier. One surface of this thermal barrier carries one or more electrodes within a radiofrequency excitable circuit as well as an associated temperature sensing circuit. The implants are located within heating channels at the interface between skin dermis and the next adjacent subcutaneous tissue layer such that the electrodes are contactable with the lower region of dermis. During therapy a conformal heat sink is positioned against the skin above the implants and a slight tamponade is applied through the heat sink to assure uniform dermis contact with electrode surfaces. An adjuvant may be employed to infiltrate dermis to significantly lower the thermal threshold transition temperature for dermis or dermis component shrinkage.

Abstract: Method, system and apparatus for carrying out accurate electrosurgical cutting. A thin resilient electrode is utilized at the forward end region of an instrument which is deployable from a longitudinally disposed slot positioned rearwardly of the tip of the instrument. Lateral sides of the slot extend between a forward location adjacent the tip and a rearward location. The electrode is deployed by urging it forwardly in compression to form an arch profile supported by the abutting slot sides adjacent the forward and rearward locations. Electrosurgically excitable with a cutting output, the electrode may carry out a cutting action both during its deployment and retraction into the noted slot. This permits a pivoting maneuver effective for circumscribing a volume of targeted tissue.

Abstract: The capture component of tissue retrieval apparatus is strengthened to improve its structural integrity when utilized within very dense tissue. Eyelet structures carrying pursing cable are improved through the utilization of slightly expanded constant widths with diminished lengths to avoid fold back phenomena. The pursing cables employed with the capture component exhibit more than a 100% improvement in tensile strength at high electrosurgical cutting temperatures through the utilization of strands having about a 1.4 mil diameter formed with a type 316 stainless steel.

Abstract: Systems and methods are provided for removing fatty tissue underlying a patient's epidermis (e.g., blepharoplasty, brow lifts, eyelid shortening procedures, and the like). These methods include positioning one or more active electrode(s) and one or more return electrode(s) in close proximity to a target site on an external body surface of the patient. A high frequency voltage difference is applied between the active and return electrode(s), and the active electrode(s) are translated across the external body surface to create an incision therein. The bipolar configuration controls the flow of current to within and around the distal end of the probe, which minimizes tissue necrosis and the conduction of current through unwanted paths in the patient. The residual heat from the electrical energy also provides simultaneous hemostasis of severed blood vessels, which increases visualization and improves recovery time for the patient.

Abstract: An electrosurgical generator which provides a constant voltage and variable power output particularly suited for cutting arc formation at an active electrode which exhibits a dynamic active surface area of varying geometry. Essentially constant voltage-based control is achieved through the utilization of a d.c. link voltage the level of which functions to establish the amplitude of the output of an RF resonant inverter. A dual loop feedback control is described wherein output voltage based control signals are slowly introduced at low gain, while link voltage motor-based controls are comparatively rapidly applied. Enhanced development of a controlling d.c. link voltage is achieved through the utilization of an input network incorporating a power factor correction stage.

Abstract: Systems and methods are provided for removing fatty tissue underlying a patient's epidermis (e.g., blepharoplasty, brow lifts, eyelid shortening procedures, and the like). These methods include positioning one or more active electrode(s) and one or more return electrode(s) in close proximity to a target site on an external body surface of the patient. A high frequency voltage difference is applied between the active and return electrode(s), and the active electrode(s) are translated across the external body surface to create an incision therein. The bipolar configuration controls the flow of current to within and around the distal end of the probe, which minimizes tissue necrosis and the conduction of current through unwanted paths in the patient. The residual heat from the electrical energy also provides simultaneous hemostasis of severed blood vessels, which increases visualization and improves recovery time for the patient.