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26
BIOMEDICAL TECHNOLOGIES
Fig. 26.1
tube) video monitor during surgery. Digital subtraction angiography (DSA), is an imaging technique that produces clear views of flowing blood in vessels and indicates the presence of blockages, if any. An angiograph (angeion : vessel; graphein : to record) is taken of the organ, for example, heart and its major blood vessels, and stored in a computer. A second angiograph is taken after a contrast agent containing iodine, which is opaque to X-rays, has been injected into the blood stream. The first image is digitally subtracted from the
Fig. 26.2
Fig. 26.3
second, leaving behind a clear outline of the blood flow to heart, brain (Fig. 26.2) or kidneys. Computed Tomography Simple radiography images are often difficult to interpret because, in them, a number of internal structures are superimposed, one on top of the other. A technique known as computed tomography (CT) or computerised axial tomography (CAT) was developed in 1972. This sensitive technique makes it possible to image the internal structures distinct from each other in a manner they would be seen in a thin section of the body (Fig. 26.3). For this invention, Godfry Hounsefield, a physicist, was awarded the Nobel Prize in 1978. The theoretical basis of this technique was provided by the work of the Indian biophysicist, Gopalsamudram N. Ramachandran. During examination, a low dose X-ray beam moves 360 o around and passes through a thin section of the body of the
patient. The rays coming out of the body are recorded by a bank of sensitive detectors. This is repeated until the same body section has been examined from all angles. A computer analyses the data and reconstructs the images of the internal organs in this section of the body. Many slices can be stacked on video screen to form a threedimensional (3D) view of a patients internal organs. Doctors get a complete series of pictures showing slices through the body at slightly different planes. This helps them pinpoint small defects. Magnetic Resonance Imaging The magnetic resonance imaging (MRI) yields the best pictorial form and it does not expose the patient to potentially harmful ionising radiations. Felix Bloch and Edward M. Purcell shared Nobel Prize for Physics (1952) for developing the basic mechanism, which now forms the basis for MRI scanning.
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MRI relies on the phenomenon known as nuclear magnetic resonance (NMR). Scientists picked hydrogen as the basis for MRI scanning because of its abundance in the body and its prominent magnetic qualities. The proton (nucleus of hydrogen atom : 1H) carries an electric charge and behaves like a miniature magnet. Under normal conditions, human body has no overall magnetic field. For MRI, the patient lies in a supine position on a couch about 2 metres wide, surrounded by the coils of a giant cylindrical electromagnet. This magnet creates a magnetic field almost 70,000 times as strong as that of the Earth. This magnetic field orients the magnetic moment of the hydrogen nuclei in such a way that they can absorb electromagnetic radiation at a definite frequency. This frequency changes when the chemical environment of the hydrogen nuclei is changed. MRI detects water because it focuses on the behaviour of hydrogen atoms in water
Tumour
Fig. 26.4
molecules. This allows MRI to distinguish between water-poor and water-rich tissues. Teeth and bones, which contain little water, do not appear in MRI. Therefore, tissues surrounded by bones, such as spinal cord, are readily observable in MRI. It is used to detect tiny lesions of multiple sclerosis on brain and spinal tissue, and to examine joint injuries and slipped disk in the spinal column. MRI can also visualise minute cancerous tumours, since radiofrequency absorbed by the hydrogen atoms in such tissues for the same field is different from that for normal tissues. The MRI scan depicted in Figure 26.4 shows a brainstem tumour. Positron Emission Tomography Positron emission tomography (PET) scanners monitor the consumption of a substance like glucose by neurons. The glucose is tagged with a radioisotope that has radioactive nuclei deficient in neutrons and with an excess of protons, e.g., 11C and 15 O. A drip delivers a small amount of this radioactive glucose into the patients blood stream, which gets distributed according to the physiological and biochemical needs of the various organs. As the radioactive atom decays, it emits a subatomic particle, called positron. Almost immediately, the emitted positron collides with its antiparticle, i.e., an electron. This collision annihilates them and releases a burst of electromagnetic energy in the form of a pair of -radiation. This double emission is the key to the PET scan. These radiations emerge simultaneously in the opposite directions and they strike crystals in a ring of detectors around the patients head, causing the crystals to light up. A computer records the location of each flash and spots the source of radiation, translating that data into a 3D-image. A metabolically active tissue will receive a greater blood supply than a relatively inactive tissue. Therefore, it will also get a greater supply of radioactive glucose, and would appear as a brighter area in the PET image. For example, the darkened area on the left side of brain in
Fig. 26.5
A PET scan of human brain showing damage in left side from stroke Colour code : Red = active : Blue = least active
Figure 26.5 indicates damage from a stroke. Bright colours in the rest of the brain show normal blood flow. Thus, by tracing the radioactive glucose, a physician can pinpoint the areas of greater brain activity, e.g., the regions of brain involved in a particular function. This versatile technique is used to study epilepsy, schizophrenia, Parkinsons disease and drug addiction. Sonography Sonography is based on ultrasound (frequency above 20 kHz). Ultrasound of frequency between 1 and 15 MHz is beamed into the human body, and the returning echoes are detected. The ultrasound waves pass through a homogenous tissue unimpeded. But when they meet another tissue or organ, a partial reflection takes place, the coefficient of
Fig. 26.6
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reflection depending upon the difference in densities of the two tissues/organs. For clinical examination, a sonographer places a scan head transducer in contact with the area to be scanned. A layer of aqueous gel is applied between the skin and scan head to ensure that the sound has an air-free path to the object of interest, e.g., a foetus. A precise sequence of ultrasound waves penetrate the body, strike the organs within and reflect back to the surface, where the transducer now functions as a receiver. The echoes are processed by a computer into a video image. The time delays of these returning signals sketch the targets location, size, shape, and even its texture. Figure 26.6 shows the face of a healthy six month old foetus, with mouth open in a yawn. Sonography, safer than radiography, is comfortable and inexpensive. It is used to assess foetal growth and to pick up a wide range of abnormalities, such as spina bifida, and conditions liable to cause difficulty in labour. Sonography is also used to image the adult body. It even provides pictures of blood flow through the beating heart, based on a phenomenon known as Doppler effect (Fig. 26.7).
Fig. 26.7
A colour sonograph using Doppler effect show blood flow through human heart. Red colour : blood flow towards the transducer; Blue colour : blood flow away from the transducer
electrical activities are traced out as wavy lines on a moving sheet (Fig. 26.9) of graph paper, or displayed on a computer screen.
Fig. 26.8
Electrocardiogram
normal. This observation suggests that the nerve bundles that coordinate the contraction of the atria and ventricles, are dispersed by inflammation or infection. The more sophisticated diagnostic electrocardiograph uses a dozen or more electrodes, placed at 6 different positions on the chest to provide a 3D map of the hearts electrical activity. ECG reveals the rate of heartbeat, and can help diagnose heart disorders following a cardiac arrest (myocardial infarction), deviations from normal pattern of heartbeat, coronary artery diseases, etc. Electroencephalography A similar technique, called electroencephalography, measures and maps transient electrical signals generated by neuronal depolarisation in the brain, and records this as an electroencephalogram (EEG). In EEG, 16 to 30 equally spaced electrodes are stuck to the patients scalp and connected to an amplifier. The patterns of
Fig. 26.9
Electroencephalogram
A typical recording takes 30 to 60 minutes. At any instant, the electrical signals, known as brain waves, on the surface of the brain, result from the synchronised activity of millions of neurons of the cerebral cortex. They are detected on the scalp and amplified about one million times before display. Although EEG traces lack the regular appearance of the ECG, their component waves can be recognised by an experienced operator. Low-frequency rhythms, called alpha waves, are present when the brain is in a relaxed state. During drowsiness or sleep, these waves are replaced by lower-frequency theta and delta waves. Theta waves normally occur in persons experiencing emotional stress. Delta waves occur during deep sleep. Higher-frequency beta waves
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are associated with mental activity in frontal areas of the brain, and during periods of sensory stimulations. The EEG is used to map regions of abnormal brain activity associated with tumours, trauma, hematomas, epilepsy and other seizure disorders and periods of unconsciousness and confusion. This is also used to identify the incidence of brain death, the complete absence of brain waves in two EEGs taken 24 hours apart. Polygraphy Polygraph is a relatively simple, compact and often portable machine that records qualitative changes in physiological parameters, rather than measuring them accurately. These parameters include vital traces, such as cardiac variables (ECG), heart pulse rate (HR), relative blood pressure (BP), the rate and depth of breathing, and the resistance of skin to the conduction of electricity, and so on. It is popularly, but quite incorrectly, called the lie detector. A modern computerised version of this multi-channel device is used to record neurophysiological parameters, such as EEG, EMG (electromyograph), EOG (electrooculograph). The main applications of this device are lie detecting, monitoring of stages of sleep, and electrophysiological behaviour of the brain and its dysfunctions.
immobilised on the surface of a petriplate or an ELISA plate. The antibody specific to this antigen is now added and allowed to react with the immobilised antigen. Unreacted antibody molecules are washed away, leaving only those antibody molecules that are bound to the antigen. Now, an anti-immunoglobulin is added and allowed to react with the antibody bound to the antigen. This anti-antibody is linked to an appropriate enzyme, e.g., peroxidase. The unreacted anti-antibody is washed away, and the substrate of the enzyme is added along with the necessary reagents. Activity of the enzyme yields a coloured product (Fig. 26.10). The intensity of colour is directly proportional to the amount of the antigen. ELISA is highly sensitive, and can detect antigens in the range of nanograms. It is a very rapid assay, and is applicable to a variety of antigens.
Endoscope tube
26.5 ENDOSCOPY
Using an endoscope (endo : within; skopein : view), a surgeon is able to carry out minor operations, without cutting through overlying tissues. The endoscope (Fig. 26.11) consists of a long flexible tube attached to a handset. The tube is inserted through an opening into the body, and its tip is steered to its destination. Bundles of optical fibres inside the endoscope transmit light to the tip. An image is formed on an array of light sensitive cells, called charge coupled device (CCD), at the tip; the electrical signal is sent up the tube along an electrical cable and fed into a videomonitor where a magnified image is seen. One channel in the endoscope carries water and air, making it possible to wash and dry the surgical site. Miniature surgical instruments, such as forceps, that are controlled by a cable running through a parallel channel, can also be taken to the site where surgery is needed. A wide variety of instruments can be fitted to the endoscope : toothed biopsy forceps allow samples of tissue to be removed for analysis; metal snares carry high-frequency electric current that can coagulate blood vessels. Endoscopes are named after the part of the body they are designed to view. For instance, a gastroscope is used to examine the
Water supply
Fig. 26.11
Endoscopy
stomach for an ulcer, a laparoscope to detect cysts or infections of the uterus, fallopian tube and ovaries, and so on.
26.7 CANCER
AND
THERAPY
Death toll from infectious diseases is decreasing, making cancer a major cause of
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death in the modern world. Therefore, it is essential to understand the biology of cancer cells. Cancer results from a breakdown of the regulatory mechanisms that govern normal cell behaviour. Thus, this disease has to be ultimately understood at the molecular and cellular levels. How Cancer Cells Differ from Normal Cells? Cell division is a highly regulated process, with a balance being maintained between production of new cells and cell death in most of the tissues and organs. Mature and differentiated normal cells have a finite life span. They are usually replaced by new cells generated by cell division and differentiation. Normally, the production of new cells is regulated in such a manner that at any given time, the number of a given cell type remains nearly constant. Normal cells live in a complex interdependent manner, regulating one anothers proliferation. Occasionally, some cells may arise, which do not respond to normal growth control mechanisms. These cells proliferate in an unregulated manner, and give rise to clones of cells that can expand to a considerable size; this growth is called tumour. All tumours are not malignant. Noncancerous tumours, commonly called benign tumours, remain confined to their original location and are incapable of indefinite growth, e.g., warts. However, malignant tumours grow rapidly, with infinite life span of the proliferating cells, and become progressively invasive. Only the malignant tumours are properly referred to as true cancer or neoplasm. Properties of Cancer Cells Cancer cells exhibit some of the following features, which distinguish them from normal cells. They show uncontrolled proliferative ability, with a reduced requirement for extracellular growth factors. They acquire the ability to invade new sites, a phenomenon designated as metastasis (Fig. 26.12). Cancer cells exhibit a number of alterations on cell surface, in the cytoplasm, and in their genes; these features are used for the identification of cancers. The ability of cancer cells to resist induction of cell death promotes the development of tumours.
(a)
in Situ
(b)
(c)
(d)
Fig. 26.12 Stages in development of cancer (a) to (d). Primary tumour may become metastatic and get transformed into secondary tumour
Types of Cancer Cancers are classified on the basis of the tissue of origin from where they arose. Most of the cancers fall into one of the following categories : Carcinomas : Cancers of this type arise from epithelial tissues, such as skin or the epithelial lining of internal organs or glands (about 85 per cent of all tumours). Melanomas : These are cancerous growths of melanocytes (a type of skin cells). Sarcomas : These are derived from tissues of mesodermal origin, e.g., bone, fat and cartilage. They are rare in humans (about 1 per cent of all tumours). Leukemias and lymphomas : These are tumours of the haematopoietic cells. Causes of Cancer Chemical or physical agents that can cause cancer are known as carcinogens. Depending on their mode of action, carcinogens fall into the following main categories : (i) Agents that can cause alterations in the genetic material (DNA), resulting in oncogenic transformation that can lead to cancer, e.g., various types of radiations, and chemicals. (ii) Agents that promote the proliferation of cells, which have already undergone genetic alterations responsible for oncogenic transformation. These agents are called tumour promoters, e.g., some growth factors and hormones. (iii) Cancer causing DNA and RNA viruses (tumour viruses) have been shown to be associated with oncogenic transformation. Cancer and Genes Normal cell growth is under the control of some critical regulatory genes, which regulate cell proliferation, differentiation and survival. Alterations in these genes lead to oncogenic transformation. Cancer-associated genes can be divided into the following three categories : (i) Genes that induce cellular proliferation, e.g., genes encoding growth factors, growth factor receptors, transcription factors, etc. (ii) Genes that inhibit cellular proliferation (tumour suppressor genes). (iii) Genes that regulate programmed cell death.
All these genes are involved in normal growth. Cancer is caused by mutant alleles of these genes, whose products do not respond to normal regulatory signals. As a result, the mutated cell proliferates uncontrollably. How Cancer Spreads Tumour growth starts in one location where an altered cell proliferates, giving rise to a clone of proliferative cells. This excessive proliferation gives rise to a mass of cells, initially known as benign tumour. The tumour cells enter into blood vessels and get spread at secondary locations; such tumour cells are known as malignant cells. Detection and Diagnosis Cancer diagnosis is based on the characteristic histological features of malignant cells. Blood tests for abnormal WBCs and bone marrow biopsy are also used. Non-invasive techniques, like X-ray (using injected dyes), CT scans and MRI scans can be used to detect cancers of internal organs like kidneys and pancreas. Modern techniques monitor and detect the molecular changes that occur in cancer cells; this enables an early diagnosis of cancer. Monoclonal antibodies against cancer-specific antigens are coupled to appropriate radioisotopes. These antibodies are then used for detection of cancer. Treatment of Cancer Various approaches have been adapted for the treatment of cancer. Therapeutic strategies vary, depending on the etiology of each individual cancer. Some of the common approaches include: (i) surgery, (ii) radiotherapy, (iii) chemotherapy, and (iv) immunotherapy. These therapies can be used either singly, or in a suitable combination. Surgery : Surgical manipulation/excision of tumour mass is one of the easiest approaches in the treatment of cancer. However, surgery does not ensure that all the cancer cells have been removed. Moreover, not all tumours are accessible for surgical manipulation. Surgical reduction of tumour load is also considered advantageous prior to initiation of other therapeutic approaches. Radiation therapy : This approach focuses on lethally irradiating cells in a tumour mass. However, this approach also causes tremendous damage to several tissues in the vicinity of tumour mass.
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Chemotherapy : Several chemotherapeutic drugs are used in this strategy to kill tumour cells. Some such drugs can specifically kill tumour cells. However, majority of them have a number of side-effects. Immunotherapy : One of the recent approaches of cancer treatment involves augmentation of natural anti-cancer immunological defence mechanisms. Monoclonal antibodies have been used in various ways, e.g., radioimmunotherapy, etc., for treatment of cancer. Research is in progress to develop cancer vaccines.
26.8 TRANSPLANTATION
It involves the replacement of an injured or diseased tissue or organ, such as skin, cornea, heart, lung, kidney, liver, bone marrow, blood and pancreas. The success of organ transplants depends mainly on a proper matching of the antigens encoded by major histocompatability complex (MHC) or human leucocyte antigen (HLA) complex loci of the recipient and donor tissues (see Chapter 25). The most successful transplants are autografts (autologous graft) : transplants in which ones own tissue is grafted
to another part of the body. Isografts are transplants in which the donor and recipient are genetically identical, e.g., graft between identical twins. An allograft (allogenic graft) is a transplant between individuals of the same species, but with different MHC/HLA alleles. The success of allograft depends on the degree of matching of MHC/HLA alleles, and on administration of immunosuppressive drugs, such as cyclosporin A, to inhibit the immunological mechanisms responsible for graft rejection. However, withdrawal of the immunosuppressive treatment may result in graft rejection. A xenograft is a transplant between animals of different species. This type of transplantation is used only when human grafts are not available.
26.9 HAEMODIALYSIS
If the kidneys are so impaired by disease or injury that they are unable to excrete nitrogenous wastes and regulate pH, electrolyte level, etc. of the plasma, the blood must be cleaned by an artificial device. This is called haemodialysis (Fig. 26.13). Dialysis means the separation of large particles from smaller ones by using a selectively permeable membrane. One of the best devices
Fig. 26.13
Haemodialysis machine
for dialysis is the artificial kidney machine. A tube connects this machine with the patients radial artery. The blood flows through the tubing, and waste products, such as urea and creatinine, pass from the blood into the dialysis solution surrounding the dialysis membrane. After passing through the dialysis tubing, the blood flows back into the body of the patient. In this way, the blood is purified to the standard level.
26.10
PROSTHESIS
Prosthetics is the branch of modern surgery that deals with prosthesis, i.e., implanting of an artificial substitute for a body part within the body. Internal replacements include intraocular lens fabricated to resemble the remaining eye in colour and configuration, nose implant for cosmetic reshaping, in-the-ear electronic hearing aids, etc. External prosthesis is exemplified by artificial arm or leg for a person who has undergone amputation. Successful Jaipur Foot made of vulcanised rubber, wood and aluminium by Dr. P.K. Sethi, is a remarkable achievement (Fig. 26.14). Heart-Lung Machine Once the heart is exposed in open heart surgery, circulation and respiration are maintained by heart-lung machine. The function of heart is performed by a roller pump, whereas the oxygenation of blood is carried out by an oxygenator that acts as artificial lung. This
Fig. 26.14
machine completely takes over the functions of heart as well as lung, and the blood circulates through the body without passing through heart. This allows the surgeons to perform complex procedures (Fig. 26.15).
Fig. 26.15
Heart-lung machine
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Prosthetic Cardiac Pacemaker Cardiac pacemaker replaces the natural electrical stimulation of heart by a small electronic circuitry inserted substaneously in the upper thoracic region of the body (Fig. 26.16). Lithium composite battery provides power for about 10 years. It transmits repetitive electrical impulses to the heart in such a manner that the heart rate is maintained at a suitable level. If the heart operates normally, the mechanical pacemaker is inhibited.
called defibrillation. It is achieved by a defibrillator that gives the electric shock through large-paddle shaped electrodes pressed against the skin of the chest. Now, battery operated implantable devices are available for patients suffering from arrhythmic disorder. Angioplasty (Balloon Catheterisation) It is a technique for unblocking coronary arteries that have atherosclerotic plaque. A balloon catheter is inserted into an artery of the arm or thigh and gently guided
Fig. 26.16
Fig. 26.17
Balloon catheterisation
Defibrillator Fibrillation is abnormal and asynchronous contraction of the heart muscles so that the effectiveness of heart pumping is reduced or completely lost. Atrial fibrillation may occur in myocardial infarction, and in rheumatic heart disease. A strong electrical current passed across the chest for a short period of time can stop ventricular fibrillation. This is
through the arterial system under X-ray observation until it is threaded up into coronary artery (Fig. 26.17). Then, while dye is being released, angiograms are taken to localise the plaques. Next, the catheter is advanced to the point of obstruction and a balloon-like device is inflated with air to squash the plaques against the wall of the blood vessel, thereby clearing the channel for the
Fig. 26.18
from another part of the body is used to bypass the blocked region of a coronary artery. The two vessels used most often are the saphenous vein from the leg, and the internal mammary artery from the chest.
26.12 CRYOSURGERY
Cryosurgery, as the name implies, uses freezing temperatures to destroy tissues. Liquid nitrogen, which has a boiling point of 196 oC, is sprayed onto the tissue either directly, as in the treatment of warts, or via a hollow probe that is inserted into the tissue. Cancerous tumours can also be destroyed in this way.
26.13 IMMUNOTHERAPY
Immunotherapy is a treatment procedure that involves suppression or augmentation of immune responses, to achieve therapeutic effects. Manipulation of the immune response can be carried out by modulating various components involved in it. Cytokines are natural immunomodulators secreted by one type of immune cell that elicits response in another type of immune cell. These include interleukins, interferons and tumour necrosis factors.
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Immunomodulators are, principally, drugs that modulate the activity of a patients immune response, either up or down, until a desired level of therapeutic effect is reached. There are two general clinical approaches of immunomodulation. (i) Immunopotentiation therapies : This includes administration of immunopotentiating agents like preformed antibodies, or immunopotentiating drugs. This strategy augments the immune response. (ii) Immunosuppressive therapies : When the patients immune system becomes activated against his or her own body, in situations such as, autoimmune diseases, the response is suppressed by using specific therapies. These include inhibitors of cell division, cytokine production, etc.
(SCID), with variable degrees of success. Attempts are being made to use gene therapy for combating dreaded diseases like cancer, heart attack, etc. Gene therapy is still at experimental stages. It can be applied to only such diseases where the gene that plays the key role in disease has been identified and cloned.
Some Important STDs and Common Techniques for their Detection Causal agent Chlamydia trachomatis Detection techniques Clinical, Gram-staining of discharge, antigen detection, nucleic acid hybridisation, Polymerase chain reaction (PCR) Gram-staining of discharge, culture Microscopic examination, culture Clinical, antigen test, Polymerase chain reaction (PCR) Antibody detection, Clinical, culture Clinical, antibody detection, culture, DNA hybridisation (PCR) (usually following specific staining), detection of specific antigens/antibodies (by ELISA or some other approaches), DNA hybridisation and polymerase chain reaction (PCR). Culture allows the isolation, observation and identification of the causative organism. DNA hybridisation is based on labelled oligonucleotides (short polynucleotide sequences) that are complementary to a sequence specific to the genome of the concerned pathogen. PCR uses highly specific primers to amplify a sequence from the genome of the concerned pathogen to enable its definite detection and identification.
Nisseria gonorrhoeae Trichomonas vaginalis Herpes simplex virus Trepanoma pallidum Haemophilus ducrei Human papilloma virus
SUMMARY
Non-invasive imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), ultrasound sonography, colour doppler, digital substraction angiography (DSA), provide 2D- or 3D-pictorial representation of the body parts. These are supported and aided by physiographs such as electrocardiographs (ECG) and electroencephalographs (EEG), that allow monitoring of functional status and diagnosis of ailments. Invasive procedures, such as endoscopy, enable the doctor to view directly and/or indirectly body parts like bronchus, stomach, colon, urinary bladder, etc. A number of diagnostic kits based on recombinant DNA and hybridoma technologies, including ELISA and Western blots, are available for detection of cancers and pathogens responsible for AIDS, etc. Considerable progress
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has been made in understanding the molecular basis of carcinogenesis. New therapies, such as selective drug targeting radiation, and surgical procedures are reducing the suffering of patients and prolonging their survival. Transplantations involving organ, tissue or even cells, are now feasible, because of surgical refinements and use in immunosuppressive drugs to overcome the problem of rejection. Advancement of biomaterial sciences and biomedical engineering has given an array of medical devices which include external and internal prosthetics in implants. Immunomodulatory drugs and hormone replacement therapies may be used in the treatment of some such diseases that could not be properly managed earlier. Gene therapy is still in clinical trial stage, but it has enormous potential to treat genetic diseases and disorders. Humans can also suffer from different sexually transmitted diseases (STDs), including AIDS. These diseases are diagnosed initially on the basis of clinical symptoms. The diagnosis is confirmed by one or more of the following tests : microscopic observation, culture, antigen/antibody detection, nucleic acid hybridisation, PCR, etc.
EXERCISES
1.
Which of the following is cancer of blood? (a) (b) (c) (d) L ymphoma Leukemia Myeloma Sarcoma.
2.
Which is the most appropriate imaging technique for investigating the functions of brain? (a) (b) (c) (d) Magnetic resonance imaging Computed tomography Sonography Positron emission tomography. Excessive cell proliferation. Transformation of a benign tumour into a malignant tumour. Movement of cancerous cells from one site to another sites in the body. Transformation of a normal cell into a tumourous cell.
3.
4.
Prosthesis, that is designed to generate repetitive electrical impulses to the heart, is known as : (a) (b) (c) (d) Artificial cardiac pacemaker Heart-lung machine Artificial heart valves Intra-aortic balloon pump. Chemotherapy Radiation therapy Surgery Physiotherapy.
5.
Current treatment for cancer does not include which of the following? (a) (b) (c) (d)
6.
Mark true or false : (a) EEG reflects the generation of excitatory and inhibitory potentials in large number of neurons. (b) EEG demonstrates delta waves during relaxed consciousness. (c) ECG trace does not reveal the rate at which heart beats. (d) DSA is an imaging technique that produces clear views of flowing blood in the vessel and its blockade. Write full forms of : (a) ECG, (b) EEG, (c) CT, (d) MRI, (e) PET, (f) ELISA. What is the difference between invasive and non-invasive techniques in medical practice? Give one example of each. Discuss the medical applications of EEG.
7. 8. 9.
10. Briefly describe the principle of ultrasound and its medical applications. 11. What is the principle of MRI imaging? Describe the advantages of MRI. 12. Compare the information available from an electrocardiograph and an electroencephalograph. 13. What is a biochemical autoanalyser? How is it useful in medical diagnosis? 14. What is the principle of PET imaging? Describe briefly two important applications of this technique. 15. Briefly explain the medical application of LASERs. 16. What is prosthesis? How is cardiac pacemaker a life-saving instrument? 17. What is endoscopy? Briefly describe the medical applications of this technique. 18. What is the meaning and function of blood dialysis? 19. Briefly explain the principle and the function of ELISA. 20. Briefly describe organ transplantation and the approaches used to prevent graft rejection. 21. Briefly explain any one of the following : (a) gene therapy, (b) hormone therapy, and (c) immunotherapy.