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Cultivate Moonflowers9 Reviews
Sacramento, CA | 530-601-0368
Let us take care of the arrangements for your wedding flowers! We have over 15 years in floral arranging, and design customized and unique...(more)
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Receive a $100 discount when you book our Officiant Services and have us create your Basic Beautiful Bridal Bouquet and Boutonniere. Pricing subject to change based on location. Price quoted is within 20 miles of Sacramento.
Flowers by Rachelle9 Reviews
Chico, CA | 530-345-2661
Rachelle Nyswonger AIFD is the owner of Flowers by Rachelle. With passion and creativity I strive everyday to be sure that I provide the highest...(more)
Strelitzia Flower Company12 Reviews
Davis, CA | 530-758-5050
Your wedding flowers are going to be the second thing that your guests notice after the bride, so make sure you choose an experienced Florist that...(more)
Natural Flair Custom Floral Designs36 Reviews
Serving Sacramento El Dorado & Amador Counties
Cameron Park, CA | 530-677-0878
Natural Flair Custom Floral Designs ~ 25 Years of Floral Design Experience Natural Flair specializes in weddings, celebrations, and special...(more)
I DO FLORAL14 Reviews
Woodland, CA | 530-867-5003
My business is run out of my home. I have been creating full services for weddings for over 10 years? I have a passion for working with flowers...(more)
Viola's Floral Design6 Reviews
Roseville, CA | 916-834-6370
Location We are conveniently located in Roseville, CA. About 15 miles north of Sacramento, CA. We are a fully committed design studio. All...(more)
Belle's Lodi Flower Shop31 Reviews
Luxury Floral Design Studio
Lodi, CA | 209-369-4709
Lodi Flower Shop was opened on March 6, 1917 in Lodi by Margarite Reynolds. She was the first woman to go to the San Francisco flower market from...(more)
Shakor Decor18 Reviews
Floral | Design | Decor | Rentals
Fremont , CA | 916-670-3333
Sarah's review: Before I go into detail, I just have to say that I am so incredibly happy that Shakor Decor was a part of my wedding!... (more)
Moda: Floral & Event Design5 Reviews
Sacramento, CA | 916-572-6508
Moda offers striking, chic, and creative floral and wedding design for the distinctive couple. We would love to work with you to design something...(more)
P.S. petals and sweets7 Reviews
Auburn, CA | 530-321-8225
At P.S. Petals and Sweets, we are fresh, unique and not your everyday florist. Under new ownership as of December 2014. We are committed to quality...(more)
Petals & Plum5 Reviews
Colfax, CA | 916-223-4959
Flowers are an essence of the wedding vision. Brides search for inspiration in magazines, the media, the internet. The visions are creative...(more)
O'Shays Flowers and Antiques22 Reviews
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Kristen's review: My October wedding was full of life and color with the biggest and brightest sunflowers you have ever seen! Soo many... (more)


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ATTENTION RIC STUDENTS: Hours have been extended in OASIS and the Bursar and Records offices. Click for details.
Charles Boisvert
|Adams Library (AL) 105
(401) 456-8023
(401) 456-9621
Academic Background
|Lahey Clinic
|Clinical Psychology
|ENRM VA Medical Center
|Clinical Psychology
|University of Rhode Island
|Clinical Psychology
|Rhode Island College
|Agency Counseling
|Le Moyne College
Courses Taught
- CEP 532 - Theories and Methods of Counseling
- CEP 536 - Biological Perspectives in Mental Health
- CEP 538 - Clinical Practicum I
- CEP 539 - Clinical Practicum II
- CEP 543 - Clinical Assessment in Case Problems
- CEP 580 - Cognitive Behavioral Therapy Interventions
- CEP 590 - Independent Study
- CEP 610 - Advanced Internship in Counseling I
- CEP 611 - Advanced Internship in Counseling II
- CEP 615 - Organization, Operation, and Administration of Counseling Services in Schools
- CEP 683 - Advanced Clinical Practicum in Counseling I
- CEP 684 - Advanced Clinical Practicum in Counseling II
Clinical InterestsBrief Psychotherapy
Cognitive Behavioral Treatment for Anxiety
Schizophrenia Group Treatment
Science-Practice Relations and Clinicians' Decision Making Processes
Stress Management
Research InterestsScience-Practice Relations and Clinical Judgment
Predictors of Psychotherapy Outcome
Cognitive-Behavioral Therapy for Anxiety
Schizophrenia: Group Therapy & Information Processing Models
Stress Management & Stress-related Illnesses
The Effects of Psychiatric Labels on Shaping Perceptions
Honors2013-2014 FSEHD Bucci Family Award for Excellence in Scholarship and Service
PublicationsAhmed, M. & Boisvert, C. M. (2013). Mind Stimulation Therapy: Cognitive Interventions for Persons with Schizophrenia. New York, NY: Routledge.
Boisvert, C. M. (2010). Negative treatment effects: Is it time for a black box warning? American Psychologist, 65, 680-681.
Abed-Faghri, N., Boisvert, C. M., & Faghri, S. (2010). Understanding the expanding role of PCPs to PPCPs: Enhancing the assessment and treatment of psychiatric conditions. Mental Health in Family Medicine, 7, 17-25.
Ahmed, M., Osser, D., Boisvert, C. M. , Albert, L., & Aslam, M. (2007). Rationale for emphasis on management over treatment of schizophrenia in clinical practice. Annals of Pharmacotherapy, 41, 693-695.
Boisvert, C., & Faust, D. (2006). Practicing psychologists' knowledge of general psychotherapy research findings: Implications for science-practice relations. Professional Psychology: Research and Practice, 34. 708-716.
Ahmed, M., & Boisvert, C. (2006). Using positive psychology with special mental health populations. American Psychologist (comment), 61, 333-335.
Ahmed, M. & Boisvert, C. (2006). Using computers as visual aids to enhance communication in therapy. Computers in Human Behavior, 22, 847-855.
Boisvert, C. (2005). Interpretation in psychotherapy: Exploring its dimensions and potential consequences. Directions in Clinical and Counseling Psychology, 17, 76-83.
Ahmed, M., & Boisvert, C . (2005). Exploring unique roles for psychologists. American Psychologist (comment), 60, 732-734.
Ahmed, M., & Boisvert, C. (2003). Multimodal integrative cognitive stimulating therapy: Moving beyond the reduction of psychopathology in schizophrenia. Professional Psychology: Research and Practice, 34, 644-651.
Boisvert, C., & Faust, D. (2003). Leading researchers' consensus on psychotherapy research findings: Implications for the teaching and conduct of psychotherapy. Professional Psychology: Research and Practice, 34, 508-513.
Ahmed, M., & Boisvert, C. (2003). Enhancing communication through visual aids in clinical practice. American Psychologist, 58, 816-817.
Boisvert, C. (2003). Negative effects in psychotherapy: Research findings and clinical implications. Directions in Clinical and Counseling Psychology, 15 (4), 37-48.
Boisvert, C., & Faust, D. (2002). Iatrogenic symptoms in psychotherapy: A theoretical exploration of the potential impact of labels, language, and belief systems. American Journal of Psychotherapy, 56, 244-259.
Ahmed, M., & Boisvert, C. (2002). Cognitive skills group treatment for schizophrenia. Psychiatric Services, 53, 1476-1477.
Lanza, M., Anderson, J., Boisvert, C., et al. (2002). Assaultive behavior intervention in the veterans administration: Psychodynamic group psychotherapy compared with cognitive behavior therapy. Perspectives in Psychiatric Care, 38, 89-97.
Federman, E., Drebing, C., Boisvert, C., et al. (2000). Relationship between climate and psychiatric length of stay in veterans health administration hospitals. American Journal of Psychiatry, 157, 1669-1673.
Boisvert, C., & Faust, D. (1999). Effects of the label "schizophrenia" on causal attributions of violence. Schizophrenia Bulletin, 25, 479-491.
Ahmed, M., Bayog, F., & Boisvert, C. (1997). Computer-facilitated therapy for inpatients with schizophrenia. Psychiatric Services, 48, 1334-1335.
DissertationBoisvert, C. (1999). (APA Dissertation Research Award). Practitioners' familiarity with psychotherapy research findings and their relative weighting of research and experience in formulating beliefs. Dissertation Abstracts International, 61 (1-B) 522. (University Microfilm No. AA19960017).
Selected PresentationsAhmed, M., & Boisvert, C. M. (2013, September). Multimodal Integrative Cognitive Stimulating Therapy (MICST) for substance abuse. Workshop presented at the 26th annual Cape Cod Symposium on Addictive Disorders, Hyannis, MA
Ahmed, M., & Boisvert, C. M. (2010, September). Cognitive stimulation, mindfulness strategies, and existential perspectives in group counseling for substance abuse. Presentation conducted at the 23rd annual Cape Cod Symposium on Addictive Disorders, Hyannis, MA.
Boisvert, C. M. (2008, November). The psychobiology of stress: Fostering the mind-body connection. Presentation at the BAMSI Annual Clinicians' Conference, Taunton, MA.
Boisvert, C. M. (2004, April). Psychotherapy researchers' consensus on research findings. Research presented at the 1st annual Convocation of Scholars at Rhode Island College, Providence.
Finley, M., & Boisvert, C. (2002, October). Roles and functions of Rhode Island school counselors. Presentation at the annual meeting of the Rhode Island School Counselors' Association, Warwick, RI.
Garrison, J., & Boisvert, C. (2001, May). Coping with work place stress and frustration. Lahey Clinic Medical Center, Burlington, MA.
Boisvert, C., & Faust, D. (2000, August). Psychotherapists' familiarity with research
findings. Poster session presented at the 108th annual meeting of the American Psychological Association, Washington, DC.
Boisvert, C., & Faust, D. (1999, August). Leading psychotherapy researchers' consensus on key research findings. Poster session presented at the 107th annual meeting of the American Psychological Association, Boston.
Federman, E., Boisvert, C., & Drebing, C. (1999, August). Differences in VA inpatient service utilization rates: Weather matters. Poster session presented at the 107th annual meeting of the American Psychological Association, Boston.
Boisvert, C. (1999, May). Therapists' familiarity with psychotherapy research findings. Presentation to pre-doctoral psychology interns and post-doctoral psychology fellows at the Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA.
Boisvert, C., & Faust, D. (1995, October). The effects of psychiatric labels on causal attribution. Poster session presented at the 35th annual meeting of the New England Psychological Association, Wenham, MA.
Editorial Experience03/10–present
FAMILY PRACTICE (An International Medical Journal)
Ad-Hoc Reviewer
Ad-Hoc Reviewer Pool
Ad-Hoc Reviewer
Advisor for which Programs
|Agency Counseling
|Chemical Dependency Counseling
|School Counseling
|Mental Health Counseling
|School Counseling
Professional OrganizationsAmerican Psychological Association
- Division 12 Member (Society of Clinical Psychology)
- Division 17 Member (Society of Counseling Psychology)
- Division 29 Member (Psychotherapy)
Psychology National Honor Society-Psi Chi Chapter

subset: commoncrawl


text:
|Publication number
|Publication type
|Application number
|Publication date
|Sep 13, 2011
|Filing date
|Mar 1, 2007
|Priority date
|Mar 19, 2002
|Fee status
|Also published as
|Publication number
|Norbert F. Heske, Thomas Heske
|Original Assignee
|C. R. Bard, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (102), Referenced by (16), Classifications (32), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
This is a continuation of prior application Ser. No. 10/500,522, filed Apr. 6, 2005, which claims priority as a 371 application of PCT/DE2003/00844, filed Mar. 17, 2003, which claims priority to DE20204363.0, filed Mar. 19, 2002, DE20204362.2, filed Mar. 19, 2002, DE20204361.4, filed Mar. 19, 2002, DE10212156.7, filed Mar. 19, 2002, DE10212139.7, filed Mar. 19, 2002, DE10212155.9, filed Mar. 19, 2002, DE20209525.8, filed Jun. 19, 2002, DE20209530.4, filed Jun. 19, 2002, DE20211934.3, filed Aug. 2, 2002, and DE20215962.0, filed Oct. 17, 2002, the entireties of which are hereby incorporated by reference.
This is a national stage application under 35 USC �371 of International Application PCT/DE03/00844, filed on Mar. 17, 2003, the entire contents of which are incorporated by reference herein.
The invention pertains to a biopsy device for taking of tissues samples, which consists of a hand piece, in which a hollow biopsy needle is inserted, wherein a portion of the biopsy needle protruding from the hand piece is introduced with its sampling chamber into the tissue being investigated and the tissue is sucked into the sampling chamber by vacuum and then separated by a sample separating mechanism and finally removed.
A method and a device for cutting out tissue is already known from British Patent Publication No. GB 2018601A, in which the tissue in the biopsy needle is sucked into a cutting region under vacuum influence. In order to create a vacuum in the hollow needle, the hand piece in which the hollow needle is integrated is connected via lines to a vacuum generator situated outside of the hand piece. The cutting off of the sample is done via a cutting mechanism, which is arranged lengthwise-moveable in the hollow needle. The sample cut off is kept in the needle. After pulling the needle out from the tissue, the cut-off sample is flushed out from the tip of the needle; therefore, the hand piece is connected via other lines to devices situated outside the hand piece. The vacuum established in the hollow needle is regulated by control elements integrated in the lines.
Another biopsy mechanism is known from European Patent Publication No. EP 0890 339 A1, in which the sample is removed under vacuum influence. In the hand piece, in which the biopsy needle with cutting mechanism is integrated and inserted, the biopsy needle is connected via hose connections and lines to an external vacuum generator as well as control devices. The vacuum is brought up from below to the sample removing chamber via a channel molded onto the outer sheath of the biopsy needle. The separating device is arranged lengthwise moveable in the hollow space of the biopsy needle. By a rotary movement, combined with a manual lengthwise push, the separating device cuts the sample from the tissue. The sample is transported in the hollow channel of the separating device. A similar arrangement is also shown by U.S. Pat. No. 5,526,822, and here in particular various vacuum feed lines to the sample removal chamber are known, such as the arrangement for cutting mechanisms, in the hollow needle or coaxially as a cutting sheath, on the outside. In both biopsy mechanisms capable of removal of a sample under vacuum, the hand piece of the biopsy device is limited in its freedom of motion by at least one connection hose and/or supply cables to one or more external supply units; furthermore, the mechanisms for creating the vacuum are costly, especially in regard to the regulating mechanisms. The sample is cut out by rotating separation devices which can move lengthwise in the hollow needle chamber.
Furthermore, a suction biopsy device is known from German Patent No. DE 40 41 614 C1, which is fashioned as a manual device and which has a partial vacuum source as well as a biopsy cannula connection, which can be placed in rotation by a flexible shaft located outside the hand piece. A biopsy cannula fashioned as a hollow cannula can be mounted on the biopsy cannula connection, preferably having a revolving cutting edge sharpened at the distal end, along whose hollow channel a partial vacuum can be applied, by means of the partial vacuum source, which is configured as a piston and cylinder unit, once the hollow cannula has been positioned at a particular tissue point inside the body. A similar partial vacuum-assisted biopsy device can be found in International Publication No. WO 96/28097, which, though not specifying any hollow cannula placed in rotation, nevertheless has a syringe plunger arrangement located inside a manual device to create partial vacuum.
German Patent Publication No. DE 100 34 297 A1 describes, in contrast with the above suction biopsy arrangement with only a single hollow needle, a tissue removal endoscopy instrument, having a biopsy needle arrangement, which specifies a circumferentially sharpened hollow needle at its distal end and a hollow biopsy needle guided inside the hollow needle, wherein the internally guided biopsy needle has a recess for removal of a tissue sample at its distal end. Proximal to the hollow biopsy needle is a suctioning instrument for creating a partial vacuum. A removal of tissue occurs in that the biopsy needle arrangement is pushed in a joint position into a region of tissue being investigated, while the biopsy needle has a distal tip, which protrudes distally from the hollow needle for a length in order to facilitate the process of penetration of the biopsy needle arrangement into the tissue, on the one hand, and to prevent tissue from getting into the interior of the hollow needle, on the other hand. When the biopsy needle arrangement is suitably positioned inside the tissue, the hollow needle is pulled back proximally for a particular length, while the interior biopsy cannula remains in position and the recess is made free. The partial vacuum applied along the biopsy needle produces an active lowering or drawing of surrounding tissue parts into the recess. By controlled distal pushing of the hollow needle with its sharpened distal end beyond the biopsy needle, a portion of the tissue is separated and enclosed inside the recess of the biopsy needle. Then, by joint withdrawal of the biopsy needle arrangement, the separated tissue sample is removed from the body for examination purposes. The entire tissue removal process described above occurs in such a way that the needle movements and the application of partial vacuum are performed manually, individually and separated from each other.
On the other hand, the biopsy needle arrangement described in International Publication No. WO 98/25522 enables a spring-operated relative motion between the hollow biopsy needle, located on the interior, and the outer hollow needle surrounding the biopsy needle. In this case as well, the biopsy needle is positioned distally to the sharpened distal tip of the hollow needle in order to take a sample, there being provided a partial vacuum source for supplying a partial vacuum through the hollow biopsy needle into the area of its recess, assisting the process of bringing in the tissue. The process of positioning the biopsy needle relatively and finally inside the region of tissue being investigated is done exclusively manually. Such a positioning leads only to unsatisfactory biopsy results, especially when investigating hard tissue regions.
Likewise, a vacuum-assisted biopsy device is described in US Patent Publication No. 2001/0011156 A1, which calls for a compactly configured hand device, in whose housing all drive elements necessary for propelling the needle of the biopsy needle arrangement are provided. However, a partial vacuum source is provided separate from the hand device, which can be connected via an appropriate supply line to the needle arrangement inside the hand device at a suitable connection location.
Starting with German Patent Publication No. DE 100 34 297 A1, which is considered to be the closest state of the art, the vacuum biopsy device for removal of tissue is based on the problem of configuring the hand piece so that the sample removal sequence can be operated with one hand after being inserted by means of a coaxial cannula, or with no such cannula. The advantages of the familiar high-speed biopsy gun without vacuum, namely, the quick penetration of the needle unit, carrying the sample removal chamber into the tissue being sampled, should be retained in addition to providing a vacuum generating device that is simple, reliable, and uncomplicated in structure. The removal of the sample should be such that the pathologist obtains a sufficient quantity of untwisted tissue for evaluation.
The solution of the invention therefore comprises a tension slide that is brought into cocked position by electric motor power against the action of a spring, the needle unit being arranged on the tension slide mounted in the hand piece, wherein the sample removal chamber is shot into the tissue after releasing the cocked tension slide. The vacuum pressure-generating device, as well as other control and supply devices, are integrated in the housing of the hand piece, and the connection element, from the biopsy needle to the vacuum pressure-generating unit, is arranged directly on the housing. The vacuum pressure-generating device comprises a controllable piston/cylinder unit, having a ventilation opening, so that excess pressure can be generated in the vacuum pressure-generating device for ejection of the sample. All drive units are electrically operated, and the drive unit for the tension slide may also be used as the drive unit for the cutting sheath. The hollow biopsy needle is surrounded by an exterior coaxial cutting sheath, and at the front side of the housing there is arranged a board for actuating the electronics, in which the tension slide release is integrated.
By arranging all necessary devices in the hand piece, the hand piece is freely moveable; furthermore, high-speed electrical drive units are used exclusively, and the tension slide and the sample separating device are operated by the same drive unit. This produces a compact device, independent of other supply units. The drive units can be accommodated in a relatively small housing. Even the electronics and the operating and measuring instruments are arranged on the housing, or accommodated in it. This also applies to the power supply and the connection elements. It is therefore possible to bring together partial processes into a single control step and simplify the attendance, so that the attendance can be done with only one hand.
For an especially simple and reliable configuration of the vacuum generating device, the use of a piston/cylinder unit with ventilation possibility to create the vacuum and the excess pressure works well. Especially advantageous is the use of a familiar syringe/plunger unit, with a ventilation opening arranged in addition in the upper part of the syringe body, which is opened in order to dissipate the vacuum by further retraction of the syringe plunger. By controlling the spindle drive unit of the plunger spindle, the same plunger/syringe unit can be switched as needed from generating a vacuum to generating an excess pressure, using, to dissipate the vacuum, a ventilation opening arranged in the upper part, through which air flows in, and is compressed in the following step.
In order to control the motion of the plunger, especially in regard to switching from creation of a vacuum to dissipation of a vacuum and generating of excess pressure, a spindle drive with electric DC motor with secondary reduction gearing has proven to be advantageous as the drive unit. The measured speed of revolution of the motor represents a direct measure of the lengthwise displacement of the plunger. Since this is a high-speed DC motor, whose take-off speed is considerably reduced by a reduction gearing, the lengthwise motion of the spindle can be controlled exactly. The length of the spindle travel and thus the magnitude of the vacuum and the excess pressure can be set with appropriate setpoint values in the control electronics, e.g., the speed of revolution of the motor.
Since a sterile biopsy needle is used for each patient, it has proven to be advantageous to separate the sterile parts from other merely disinfected parts that are firmly connected to the hand piece. For this reason, it is convenient to design the vacuum pressure-generating device, the biopsy needle with cutting sheath and the parts connected to the biopsy needle and cutting sheath, such as the biopsy needle carrier, the drive elements and plastic piece including connection element and guide roller as an independent, easily inserted and removed sterile insert element. The space for the insert element is separated from the other drive elements by covers, for reasons of cleaning of the hand piece.
For sake of simplicity, the flexible connection element is fashioned as a flexible hose, so that it can adapt to the displacement travel of the tension slide. In order to allow for twisting of the hose relative to the biopsy needle at the proximal end, an additional rotary mounted plastic piece is arranged in the plastic piece firmly connected to the biopsy needle, to which the hose is attached. In order to enable a lengthwise movement of the gear connected to the spindle casing for driving of the spindle casing, e.g., when the tension slide is released, a toothed roller is provided as the drive unit. In order to provide for a cocking of the tension slide via the biopsy needle carrier by turning the cutting sheath, the gear at the end face of the threaded spindle casing is supported against a holder of the base block during the cocking process, so that the biopsy needle carrier moves to the right, while the cutting sheath maintains its position.
The locking of the tension slide has a double-arm lever, whose one arm engages under spring pressure with the recess of the tension slide. In order to allow for use of the tension device for different biopsy needles with different insertion depths, e.g., 15 to 25 mm, it is only necessary to adapt the length of the engaging lever and use appropriate settings in the electronics, for example. The plastic piece joined to the biopsy needle enables a turning of the sample removal chamber by means of a knurled disk. The biopsy needle can be locked in the desired position by the interaction of the polygon of the plastic piece and the biopsy needle carrier. A notch made in the knurled disk shows the user the radial position for the opening of the sample removal chamber.
The cross section of the hollow biopsy needle is limited by a narrowing, a stuffing, or a lip at the sample removal chamber. This narrowing is around 60-75% of the height and closes off the upper open part of the sample removal chamber from above. This narrowing in front of the sample removal chamber has the effect that the vacuum sucks in the tissue being investigated from the bottom—upon opening of the sample removal chamber—(i.e., upon retraction of the cutting sheath). The narrowing in addition prevents tissue from getting into the rear part of the hollow needle space. When the sample is ejected, the narrowing produces a pressure increase in the sample removal chamber, which improves the cleaning effect, especially in the sample removal chamber. By applying the vacuum, the tissue of the sample is sucked into the interior of the sample removal chamber and clings more or less to the inner wall. For better adhesion, additional means can be provided in the interior of the sample removal chamber. Since the cutting sheath is arranged on the outer diameter of the biopsy needle and thus the separation of the tissue occurs externally, the tissue clinging to the inner space is not detached from the inner wall by the cutting mechanism, thanks to the external arrangement of the cutting sheath. Furthermore, the tissue cannot get into the cavity of the rotating cutting mechanism and get stuck inside. Guiding of the cutting sheath with its round cross section on the outer side of the biopsy needle with its round cross section has the advantage that no twisting (turning) of the sample can occur by the cutting rotation of the cutting mechanism, thus fulfilling a major requirement for the evaluation of the tissue by the pathologist. In order to achieve a good adhesion of the sample in the inner space without impairing the fill ratio, the sample removal chamber is configured so that approximately 25% of its cross section is open for suctioning in the sample, i.e., the larger portion of the circumference is closed.
The arrangement of the coaxial cutting sheath on the outside also has the effect that a larger sample can be removed than when the cutting sheath is arranged on the inside. Since the sample is ejected with assistance from a pressure built up from the sample removal chamber, no damage to the tissue occurs when taking the tissue out. Thanks to the central arrangement of the base block at the center of the inner chamber of the housing, the housing itself is protected against transverse forces produced by the drive elements. Furthermore, it is easy to replace the drive units, as well as the tension slide, since it is only necessary to loosen the connections to the housing for this. It is also advantageous that the impacts produced by the plastic tension slide are absorbed by the base block.
The storing of the biopsy needle/cutting sheath in a biopsy needle carrier made of plastic has the advantage, among others, that the molded-on sliding surfaces enable a trouble-free sliding on the opposing surfaces of the base block and the molded-on block. The biopsy needle carrier transmits the forces from the spindle drive of the cutting sheath to the tension slide. Since the spindle drive thrusts against the holder of the base block when the tension slide changes position and it can slide freely when the tension sheath is rotated (the gear can slide axially in the toothed roller), the drive unit can be used for both motion sequences (tensioning of the tension slide, opening and closing of the sample removal chamber by means of the cutting sheath). The miniature switch integrated in the housing end piece, which turns the power supply off and on by the closing of the housing cover with the vacuum pressure-generating device inserted, as well as the retaining tabs arranged on the biopsy needle carrier, are safety mechanisms which prevent a tensioning of the tension slide when the housing cover is open. Furthermore, an opening of the housing cover when the needle is under tension will be precluded.
The guide roller, mounted in the end cover of the housing with the biopsy needle and cutting sheath passing through it, cooperates with the cannula which has been inserted into the tissue. Because a seal element is placed on the proximal end of the previously mounted coaxial cannula, interacting with the cutting sheath, air is prevented from getting in between the cannula and the cutting sheath. The guide roller placed on the cannula prevents the inner housing from getting dirty and prevents the nonsterilized hand piece from touching the coaxial cannula. The board arranged on the hand piece with integrated light-emitting diodes and switches, as well as icons, accomplishes a simple operator guidance. The cover plate can also be used as a carrier for miniature switches or photocells. The insertion aid enables easier insertion of the sterilized replacement element.
In order to make sure that the tissue is reliably cut through when the sample removal chamber is closed, the cutting sheath travels by approximately 2 mm out toward the tip of the needle, beyond the distal end of the sample removal chamber. To prevent operator error, the sequences "cocking of the tension slide" and "ejection of sample" are provided with delay circuits. To enhance the safety, it may be advisable to select a different color for the light-emitting diodes in the case of processes taking place in the tissue, such as "separate the sample", than that for processes taking place outside the tissue, such as "eject the sample".
When using a coaxial cannula in which the needle unit is inserted, so as to achieve an exact positioning, for example, one must make sure that no air can get in between the outer circumference of the needle and the inside of the coaxial cannula when a vacuum is produced. Therefore, a seal element is provided at the proximal side of the coaxial cannula tube. Since the depth of insertion of the needle unit is dictated by the cocking distance of the tension slide, unless means are provided in the hand piece for different depths of insertion, the use of spacing pieces between the coaxial cannula and guide roller has proven to be especially advantageous. The spacing piece is strung onto the needle unit and sits distally on the proximal end of the coaxial cannula, and proximally on a guide roller arranged in the hand piece. As a result, for the same insertion length dictated by the device, the depth of penetration is reduced by the length of the spacing piece, resulting in easier production conditions.
The invention shall now be described as an example by means of sample embodiments making reference to the drawings, without limiting the general notion of the invention.
The following detailed description should be read with reference to the drawings, in which like elements in different drawings are identically numbered. The drawings, which are not necessarily to scale, depict selected preferred embodiments and are not intended to limit the scope of the invention. The detailed description illustrates by way of example, not by way of limitation, the principles of the invention. This description will clearly enable one skilled in the art to make and use the invention, and describes several embodiments, adaptations, variations, alternatives and uses of the invention, including what is presently believed to be the best mode of carrying out the invention.
Integrated in the housing interior of a hand piece 1 are all devices required to perform a vacuum biopsy (
From the distal part of the left end cover 6 protrudes the distal part of the hollow biopsy needle 2 with the cutting sheath 3 surrounding it coaxially, which is required to remove the tissue sample. Usually, a coaxial cannula is placed in the tissue, into which the biopsy needle 2 with cutting sheath 3 is introduced. Outside the right end cover 7 of the housing there is arranged a connection element 4, e.g., a transparent flexible hose, which connects the vacuum pressure-generating device 5, arranged in parallel with the biopsy needle, to the interior cavity of the biopsy needle 2. The hollow connection element 4 is situated in immediate proximity to the end cover 7 of the housing. The biopsy needle with cutting sheath and additional elements, arranged in a biopsy needle carrier 37, forms together with the connection element 4 and the vacuum pressure-generating device 5 an element 20, easily inserted or taken out at the top, which is replaced as necessary (
In the sample embodiment described hereafter, the vacuum pressure-generating device is arranged in parallel with the biopsy needle. However, in the scope of the invention, the vacuum pressure-generating device can also be arranged lying in the axis of the biopsy needle or the hand piece; neither does it require its own connection element, if for example it is mounted directly on the end of the biopsy needle.
Between the left and right end covers 6, 7 of the housing is the lower piece 9 of the housing and a housing cover 10 which is hinged in the end covers of the housing, with a locking latch 11. By means of tie rods or screws, which are partly screwed into a base block 8, the lower piece 9 of the housing is clamped between the end covers 6, 7, or it is joined to the base block 8. The housing cover 10 can swivel about an axis secured in the end covers 6, 7 of the housing. The housing cover 10 is closed before the biopsy mechanism is used; the inner contour of the housing cover corresponds to the outer contour of the biopsy needle carrier 37, which will be described more precisely hereafter. Approximately at the center of the interior space of the housing is arranged the base block 8, which is firmly connected to the lower piece of the housing, for example, by fixation elements and/or by a screw connection. The base block 8, which extends not only in the lengthwise axis from the middle to the left, but also across the entire transverse surface, is connected to the drive elements for the vacuum pressure-generating device 5, the cutting sheath 3 and the cocking mechanism for the tension slide 28, on which the biopsy needle carrier 37 is mounted. Furthermore, the base block 8 has a holder 36, open at the top, for the biopsy needle/cutting sheath, and an additional insert element 62 for the vacuum pressure-generating device.
In order to specify the position of the individual elements, as well as the position of the individual parts, especially in the interior of the housing, a coordinate scale has been drawn in
Making reference to these remarks, in the bottom, front, left part of the housing interior are found the joint actuating mechanisms 106 for the cocking mechanism and the cutting sheath, and in the bottom, rear, left part of the housing is the actuating mechanism 105 (
In the uppermost front part of the housing interior there is arranged a biopsy needle carrier 37, which can be inserted into and taken out from the U-shaped insert holder 36 of the base block 8, which is open at the top, and the bracket 40 arranged on either side of the tension slide 28 and pointing upward; the biopsy needle/cutting sheath unit with actuating parts is moveably mounted in this, extending for almost the entire length of the hand piece. This means that, in the uncocked state, the left end surface of the biopsy needle carrier 37 lies against the left end cover 6 of the housing, and in the cocked state the right end surface lies against the right end cover 7. "Almost the entire length" means that the biopsy needle carrier is at least shorter by the distance required in the interior of the housing for the cocking sequence. If the cocking distance of the tension slide is 20 mm, for example, the biopsy needle carrier must be able to move by this amount. In general, the cocking distance is between 15 and 25 mm, depending on the biopsy needle used. It is therefore advisable to design the interior for the longest possible cocking distance.
The cocking device (situated right front) itself consists of a tension slide 28, placed on a bolt 30, the bolt screwing into the base block 8. The bolt 30 has a spiral spring 31 surrounding it. The locking device (see especially
The hand piece, and also in particular the biopsy needle or the vacuum pressure-generating device, are not connected either by cable or hose lines to additional supply units situated outside of the housing hand piece. Therefore, the mobility and maneuverability is not impaired either by lines or by cables. The housing cover, the bottom piece of the housing, the end covers of the housing and the base block consist preferably of aluminum.
The hand piece 1 consists, as already specified, of a housing, which is formed from a housing lower piece 9 with side walls raised to different height, the housing cover 10 adapted to the lower piece of the housing with lengthwise moveable locking latch 11, and the two end covers 6 and 7. The lower piece of the housing is joined to the two end covers by tie rods or screws, e.g., made of iron, which are partly screwed directly into the base block 8. The housing is around 200 mm in length, the end covers have approximately square cross section, roughly 40�40 mm (
The left end cover 6 has, in the upper forward part, an upward open U-shaped passage 13 for the forward protruding part of the biopsy needle/cutting sheath 2, 3 and the guide roller 81 mounted thereon. The rear end cover 7 of the housing has two upward open U-shaped passages 15, 16. The passage 15 corresponds to the passage 13; it receives the end of the plastic part 47, with round cross section, mounted on the hollow biopsy needle. In passage 16 is inserted a connection piece 63 for the vacuum pressure-generating device (
At the front side of the bottom piece 9 of the housing there is a surface 113 provided for the board with the operating and monitoring elements (
When configuring the operating and monitoring elements consideration was given to the difference between the cocking sequence of the tension slide and the triggering of the tension slide, on the one hand, and the performance of the biopsy, such as the cutting out of the sample, as well as the removal of the sample with the ejection of the sample, on the other hand. Accordingly, the activating button 88 (trigger) for the tension slide has been placed at the right and the cocking button 90 for cocking the tension slide is at left. The program button 89 for performing the biopsy is in the middle. It is necessary to press the program button for three functions. The first function, start or reset, is indicated by the reset diode 91, while the sample removal diode 92 arranged underneath indicates the opening and closing of the sample removal chamber when removing the sample. The lowermost eject diode 93 indicates the ejection of the removed sample. The cocking diode 94 indicates the cocking of the tension slide; the locking diode 95 indicates the locking of the tension slide. The battery charge diode 96 indicates the charge condition of the battery or storage battery. The diodes are switched so that the diode blinks while performing the particular sequence and after completion of the sequence the diode remains lit. When there are two possible choices, both diodes are lit. The operator is then free to make a choice. The mode of operation and possibility of control shall be examined more closely in detail when describing the sequence. Symbols (icons) at the margin symbolize the individual processes.
To improve the operating safety it may be advisable to outfit individual automated sequences with delay circuit. In particular, it has been found that the processes of "cocking of the tension slide" by pressing the cocking button 90 and "ejection of sample" by pressing the program button 89 are provided with delay circuits of around 1.2-1.5 seconds to improve the operating safety. Furthermore, the operating safety is improved when the light-emitting diodes indicating the individual processes have different colors for processes outside and processes inside the tissue.
A perspective representation of the base block 8 (looking from the front in the direction of the X-axis) is shown by
An additional block 26 is molded on the wall 22, pointing to the right, which accommodates both the swiveling double lever 33 for the locking process and also serves to fasten the bolt 30 for guiding the tension slide 28. The bolt 30 is screwed into the threaded borehole 29. During the cocking process, the tension slide 28 moves to the right on the bolt 30 and the separating plate 114 is arranged underneath. The spiral spring 31 arranged on the threaded bolt 30 is compressed during the cocking process. At one end, the spiral spring thrusts against an end piece 32 of the threaded bolt or directly against the end cover 7 of the housing; the other end of the spiral spring thrusts against the end of the guide borehole 115 of the tension slide.
The tension slide 28 moves on the threaded bolt and the separating plate 114 and is thus prevented from twisting. One arm 99 of the double-arm lever 33 of the locking device engages with a groove 27 of the tension slide 28 (
The tension slide 28, which adjoins the block 26, is arranged at equal height and is roughly equal in cross section. On its top side, the tension slide has two brackets 40. The upward pointing surface 41 of the tension slide, as well as the upward pointing surface 44 of the block 26, and the upward pointing surface of the extension 42 of the basic block 8, together form a planar bearing surface for the lower sliding surface 43 of the biopsy needle carrier 37 mounted thereon. The biopsy needle carrier is made of plastic. As the tension slide is moved from the starting uncocked condition (
Above the U-shaped space 24 for the toothed roller 23, at the height of the sliding surface 42, the basic block 8 has a U-shaped upwardly open holder 36, for inserting the biopsy needle/cutting sheath among other things. This holder serves primarily as a radial thrust bearing, i.e., as a prop for the actuating part connected to the cutting sheath, the gear 74, or the plastic disk 78, in order to bring the tension slide into its cocked position by means of the actuating device 106, as shall be described afterwards. In the upper rear part of the base block there is provided another U-shaped insert element 62, in which the free end 61 of the threaded spindle of the vacuum pressure-generating device 5 is inserted. In the middle, top, of the base block 8 is the recess 45, into which the dog 12 of the locking latch 11 of the housing cover is forced. A cover 46 arranged on the base block 8, pointing to the left, separates the space of the actuating motors and the board from the upper left part of the housing interior, which is used primarily to keep the exchangeable biopsy needle carrier 37, including biopsy needle and cutting sheath. The cover 46 protects the electric gear motors and the board against dirt. The board for the electronics lies between the actuating motors and underneath the middle rib.
At the other, proximal end of the cutting sheath, away from the cutting edge 72, there is fastened a threaded spindle casing 73 with a gear 74 arranged at the end face of the threaded spindle casing. The threaded spindle casing with gear is arranged on the cutting sheath and prevented from turning and shifting. The threaded spindle cooperates with a threaded spindle nut 75, which is firmly press-fitted in the biopsy needle carrier 37. The gear 74 lies to the left, i.e., before the spindle casing begins. When the threaded spindle casing is turned by means of the gear 74, the cutting sheath is rotated and shifted in lengthwise direction along the biopsy needle 2.
The gear 74 at the left end of the threaded spindle engages with the toothed roller 23 after the biopsy needle carrier is inserted in the brackets 40. So as to allow for inserting the biopsy needle carrier 37 into the brackets of the tension slide when the slide is not cocked (
The right end of the cutting sheath is connected to the hollow biopsy needle by a seal element 76, able to move in rotation, but air-tight, so that neither air can get in between biopsy needle and the cutting sheath coaxially surrounding it, nor can air escape during excess pressure. On the right end of the biopsy needle 2 is mounted air-tight a round, likewise hollow plastic part 47, being frictionally joined to the biopsy needle. The plastic part 47 has a bearing element 49 at its left end, which is press-fitted into the biopsy needle carrier; at its right end, protruding from the hand piece 1, there is inserted another plastic part 112, which can turn relative to the plastic part 47 and the biopsy needle 2. Between biopsy needle and plastic part 112 there is inserted an O-ring seal. The plastic part has a plug 17 at its right end, onto which the connection element 4 is placed air-tight.
There is also a knurled disk 80 on the right part, protruding from the biopsy needle carrier and the housing, by which, when rotated, the position of the sample removal chamber can be adjusted radially, without altering the position of the cutting sheath. One rotation of the biopsy needle involves only one rotation of the sample removal chamber and, thus, the sample removal device. The plastic part 47 with biopsy needle and cutting sheath is press-fitted into the biopsy needle carrier with the bearing element 49 and the threaded spindle nut 75. The biopsy needle can rotate in the biopsy needle carrier and is mounted in the cutting sheath by the bearing element 49 and its narrow guide in the cutting sheath, and it can shift in the lengthwise axis with the biopsy needle carrier. As described above, the cutting sheath is axially movable by rotation relative to the biopsy needle. To the right of the bearing element 49 a polygon 50 is arranged on the plastic part, which can lock with the biopsy needle carrier by tension, so that the sample removal chamber of the biopsy needle can be brought into the most favorable position for the biopsy removal and held there by means of the knurled disk 80.
Details of the sample removal chamber and the tip of the biopsy needle are represented in
When there is excess pressure in the cavity of the biopsy needle, the narrowing or stopper has a pressure boosting effect. The stopper has roughly the length of 10 mm and is glued or welded into the cavity. When using laser welding, it has proven to be advantageous to make the left side of the stopper thin for a short length, around 2 mm, by removing material at the end surface. As a result, in this region at the end surface the tube of the biopsy needle is welded to the end surface of the stopper and is air-tight at the end surface. The stopper can also be of shorter length, as long as the same effect is achieved. Thus, the stopper can also be replaced by a lip or dog of approximately the same height. The important thing is that the narrowing is configured such that the vacuum is brought to bear primarily from the bottom in the sample removal chamber, so that the sample clings to the wall of the sample removal chamber during the cutting process and does not change in length. It has also proven to be advantageous to provide additional fixation means on the sample removal wall.
The suctioning of the sample from the bottom into the sample removal chamber produces, first, a high fill ratio of the sample removal chamber and, second, especially thanks to its configuration, a good fixation of the sample on the wall. Since the cutting sheath separates the sample at the outside of the biopsy needle, this firm suctioning of the sample into the interior is also preserved during the separation process. Furthermore, thanks to the cutting sheath arranged on the outside, thanks to the vacuum applied, no tissue is suctioned into the hollow cutting sheath and thus the tissue cannot get twisted or turned by the rotating lengthwise movement of the cutting sheath, as it is held fast in the interior of the cutting sheath. This improves the quality of the sample, since the pathologist obtains original material corresponding to the cross section of the cut and not being twisted or deformed. When the sample is ejected under pressure, a complete cleaning of the sample removal chamber occurs in addition through the stopper 79, so that no comingling occurs when used repeatedly. Since the vacuum generating device is used at the same time as a pressure generating device, the entire cavity is cleaned, especially that of the needle.
The toothed crown 55 arranged on the circumference of the threaded spindle nut meshes with the drive pinion 56, which is fastened on the take-off shaft of the DC gear motor 58. The take-off shaft of the DC gear motor 58 is mounted in the base block 8; for this, the take-off shaft is inserted into the transverse plate 59 of the base block. When the DC gear motor 58 is activated, the plunger is moved toward the syringe bottom or in the direction of the base block 8, depending on the direction of turning. The drive motor used is likewise a DC motor with high speed, connected to a planet transmission with high reduction ratio. It corresponds to the motor already described for the cocking mechanism.
The plunger 54 is configured in familiar fashion as a syringe plunger. The syringe body made from plastic, being a cylinder with a bottom, is transparent. In order to prevent a twisting of the threaded spindle 53 upon actuation of the threaded spindle nut, the two opposite surfaces 60 of the threaded spindle are planar in configuration (
In order to make the threaded spindle easy to turn, the threaded spindle nut with toothed crown has a chamfer 66 around 1.5 mm in thickness at the side facing the base block. Since, furthermore, the surface of the rib 59 on the base block 8, which interacts with the chamfer 66 of the threaded spindle nut 48, is inclined from top to bottom, the vacuum pressure-generating device is pulled downward during operation. To create a sufficient vacuum of around 200 hph in the sample removal chamber, for example, when using a biopsy needle with length of around 250 mm and an internal diameter of the hollow biopsy needle of around 5 mm, one uses a syringe body for 20 ml with a length of around 90 mm. In order to be able to use the syringe body also as a pressure generator, a ventilation opening 67 of around 1.5 mm diameter, for example, is provided after around � of its length, corresponding to the stroke for producing the vacuum (position per
If the syringe plunger is moved beyond the ventilation opening 67 (
The handling of the biopsy mechanism shall now be explained more fully. The removable insert element 20, comprising a vacuum pressure-generating device, elastic connection element, biopsy needle carrier with needle and cutting sheath and additional elements connected to it, also contains a guide roller 81 mounted on the needle. This unit, including an insert aid, comes in a sterile package. The plunger 54 in the syringe body 52 comes slightly (1-2 mm) lifted up from the syringe bottom, the sample removal chamber 71 of the biopsy needle 2 is open so that one can make a visual inspection of the chamber prior to inserting. After opening the housing cover 10, the carrier element 37, including biopsy needle 2, cutting mechanism 3, and other parts connected with it, such as the vacuum pressure-generating device 5 hooked up to the connection element 4, is inserted into the connection element provided for this (
During the insertion process, one must make sure that the gear 74 engages with the teeth of the toothed roller 23; the cutting sheath is inserted from above into the U-shaped holder 36, and at the same time the brackets 40 of the tension slide are introduced into the recesses 77 of the carrier element; the guide roller 81 is inserted in the passage 13, so that the flanks 101 and 102 embrace the left end cover 6. The cutting sheath is mounted in the guide roller, able to move lengthwise and turn freely; the guide roller itself, however, can no longer move relative to the cutting sheath after being inserted in the left end cover 6. The vacuum pressure-generating device is then inserted at one end into the upward-open insert element 62 of the base block 8 by its free end 61 and at the other end into the U-shaped, upward-open passage 16 by the connection piece 63. The connection piece 63 lies above the switch pin 19.
Since the insert element at the base block has a clear width which just allows the inserting of the threaded spindle provided with surfaces 60 at either end, the threaded spindle is held in the insert element, secure from turning. The toothed crown 55 of the threaded spindle nut 48 engages with the take-off pinion 56 of the gear motor after being inserted. The spacing between the base block at one end and the housing end cover 7 at the other is maintained so that syringe body 52 with the threaded spindle nut 48 placed on the syringe body has just enough room. The unit formed by the syringe body and the mounted gear is held in this way so that it cannot shift axially. After being inserted, the vacuum pressure-generating device lies parallel to the biopsy needle carrier; the connection element describes an arc of around 180�. It should further be noted that the inserting is done when the tension slide is not cocked; this means that the gear 74 engages at the right end of the toothed roller with the sample removal chamber open (
When the housing cover is closed, the connection piece 63 is forced downward and activates the miniature switch by the switch pin 19 built into the end cover of the housing. This activates the electrical system, which is indicated by blinking of the reset diode 91 on the front side of the hand piece 1. The reset diode at first blinks green, which means that the positioning of the individual elements, i.e., the inserting process, is not yet finished; the DC gear motor 21 must first close the sample removal chamber 71 with the cutting sheath 3 (the sample removal chamber was partly opened during the inserting). This occurs by twisting the threaded casing connected to the cutting sheath. The cutting sheath moves to the left until the gear 74 comes to bear against the inside of the holder 36. After closing the sample removal chamber, the plastic disk 78 bears against the holder 36 (inside). During this process, or before or after it, the DC gear motor 58 brings the syringe plunger 54 to bear against the syringe bottom 51.
After the starting positions are reached for the vacuum pressure-generating device and the biopsy needle/cutting sheath, the cocking diode 94 and the sample removal diode 92 light up green, and the reset diode goes out. The operator must now decide whether to initiate the cocking of the tension slide or to remove an additional sample, e.g., because he has already previously removed one tissue sample. If the operator presses the cocking button 90, the cocking of the tension slide is initiated; the cocking diode blinks green, the sample removal diode 92 goes out. By pressing the cocking button, the electrical DC gear motor 21 receives current and the DC gear motor actuates the toothed roller 23. The gear 74 meshing with the toothed roller 23 turns the spindle shaft and at the same time the cutting sheath 3 connected to it. Since the spindle nut 75 is press-fitted in the biopsy needle carrier 37 and the gear 74 is supported by the plastic disk 78 against the holder 36, which is firmly connected to the housing by the base block 8, the turning of the threaded spindle casing 73 has the effect of moving the biopsy needle carrier to the right.
At the same time, the biopsy needle 2 connected to the biopsy needle carrier by the bearing element 49 is carried along, resulting in the tip of the biopsy needle moving into the cutting sheath. The biopsy needle carrier 37 is moved to the right by the recess/bracket connection of the tension slide against the action of the spiral spring 31 until the lever 33 of the locking element is forced into the recess 82 of the tension slide by the spring 34. The tension slide is locked in this position. The gear motor receives the control command that the locking position has been reached, e.g., via a photocell installed in the sliding surface of the cover plate, which interacts with the retracted biopsy needle carrier; the direction of turning of the motor is reversed and the cutting sheath is turned back to the right by the amount that the cutting sheath had moved beyond the tip of the biopsy needle by the movement of the tension slide and the biopsy needle.
At the end of this step, the cutting sheath completely closes the sample removal chamber (
The shot is triggered by pressing the activation button 88. This has the result of swiveling the double-arm lever 33 about the axis 35 to release the tension slide. The tension slide is hurled to the left by spring action. The sample removal diode lights up green, the cocking diode goes out. By operating the program button 89, the sample removal sequence is enabled; the sample removal diode 92 blinks green. At first, the DC gear motor 58 will activate the vacuum pressure-generating device. The plunger of the vacuum pressure-generating device is moved in the direction of the base block, i.e., away from the bottom of the syringe, until it reaches a position just before clearing the ventilation borehole 67 (
It has proven to be advantageous to direct the partial vacuum by the stopper 79 primarily at the lower region, the lower side, of the sample removal chamber, and the stopper 79 will prevent or impede tissue from getting into the biopsy hollow needle. When the sample removal chamber is fully open—the tissue sample is accommodated in the sample removal chamber—the gear motor 21 is reversed and the sample removal chamber is closed. By turning the cutting sheath, the tissue is separated by the cutting edge 72 of the sheath 3 during the closing process. In order to reliably cut through the tissue filaments, it is advantageous to move the cutting sheath 3 beyond the distal end of the sample removal chamber (around 2 mm). In order to accomplish this, it is only necessary to program accordingly the microprocessor where the control data is kept. Because of the special configuration of the sample removal chamber and thanks to the vacuum applied, the tissue sample is held in the chamber without torsion, so that the tissue sample is not twisted or turned by the rotating and lengthwise moveable cutting sheath 3 which surrounds the biopsy needle on the outside, as described.
After the sample removal chamber is closed, the DC gear motor is activated for the vacuum generating unit 5. The plunger 54 is first retracted far enough to clear the ventilation opening (
The gear motor 21 moves the cutting sheath back across the sample removal chamber after the plunger has reached the plunger bottom. Thanks to the excess pressure built up in the system, the sample is forced out under pressure into a waiting laboratory vessel even when the sample removal chamber is halfway open, and at the same time the cavity of the vacuum pressure-generating device, the biopsy needle and the sample removal chamber is cleared of tissue particles and fluid. The ejection of the sample when the sample removal chamber is around halfway open is so that the ejection of the tissue sample is assured and the tissue sample does not fall back into the chamber as a result of premature dissipation of the excess pressure. The narrowing of the cavity of the biopsy needle by the stopper 79, which prevents or impedes tissue from getting into the cavity of the biopsy needle, proves to be especially advantageous when removing the sample, since the narrower cross section boosts the ejection pressure. The best ejection results were therefore achieved with the sample removal chamber halfway open; i.e., the cutting sheath clears half of the sample removal chamber. The excess pressure also forces tissue fluid out of the sample removal chamber and cleans it.
After the sample removal chamber is fully open, the removal and cleaning is finished, and the ejection diode goes out. The reset diode 91 lights up green. If no further samples are to be removed now, the housing cover is opened and the removable element 20 is taken out. When the housing cover 10 is opened, the system is deactivated by the miniature switch 18. However, if an additional sample is to be taken from the same tissue environment, the operator presses the program button 89 and the reset diode 91 starts to blink. The vacuum pressure-generating device, as well as the cutting sheath, are again adjusted as described. At the end of the process, the reset diode 91 goes out and the sample removal diode lights up. The next steps of the process occur in the sequence already described. The process can be repeated as often as desired. At the end, the operator need only decide whether to take another sample or to conclude the sampling and open the housing cover.
As already described, in order to enhance the operating safety, a delay circuit can be provided for individual steps such as "cocking" and "ejection of sample". Furthermore, the light-emitting diodes can have different colors, so that one can distinguish between work in the tissue and that outside the tissue. If it is required to take the sample from a location of the tumor that does not lie directly above or at the sample removal chamber after being inserted, i.e., it lies to the side, the position of the sample removal chamber 71 can be turned by means of the knurled disk 80. So that the operator can recognize this radial positioning of the sample removal chamber, a marking in the form of a notch 119 is made on the knurled disk, pointing upward when the opening of the sample removal chamber points upward. The biopsy needle is fixed in the particular position by the surfaces of the polygon 50 and the elastic forces in the carrier piece. The sampling process is the same as already described.
After completion of the biopsy, the interchangeable element 20 (vacuum/pressure device, biopsy needle/cutting device with all elements arranged on it) is removed from the top after releasing the cover. To make it impossible to open the housing when the tension slide is cocked, a safety tab 84 is arranged on the biopsy needle carrier, which bears against the left end surface 85 of the closure mechanism in the cocked condition. In this way, the closure mechanism, moveable in the X-axis, can no longer be moved to the left into the open position and thus the dog 12 can no longer be taken out from the recess 45. On the other hand, the housing cover also cannot be closed if the carrier unit has been inserted in the cocked condition, since the safety tab prevents the latch from being introduced into its designated space. The surface 85 of the latch adjoins the safety tab. The battery charge diode 96 is turned off as soon as the housing cover is opened. When the cover is closed and the insert element 20 is installed, the battery charge diode indicates whether sufficient energy is available.
Basically, it is conceivable to control all steps individually by hand for the removal of a sample, as well as the cocking of the slide, etc., by activating and deactivating the two gear motors. However, it is expedient to group together the individual steps of the sequence and have them run automatically, with only the following step initiated by activating a switch. This semiautomatic method, as described above, has proven to be especially advantageous.
Basically, there are two conceivable methods for detecting the actual values and comparing them to the nominal values. One method is based on measuring the lengthwise displacement of the threaded spindle as it is pulled out or pushed in, and measuring the axial displacement of the cutting sheath or the biopsy needle carrier. In order to detect these changes, photocells or miniature switches are arranged inside the housing, in particular on the extension of the base block 8. In addition, a positioning finger 103 is mounted on the cutting sheath, while the free end 61 protruding from the plunger unit can be used as a measuring point for the threaded spindle of the vacuum pressure-generating device; if the front edge of the biopsy needle carrier is used as a measuring point with a photocell, no additional positioning finger is required. The embedded photocells are covered with suitable transparent material in case of possible contamination. The positioning finger 103 engages with a slot in the biopsy needle holder. At appropriate places on the extension of the base block 8 there are provided recesses 107, in which photocells or miniature switches are installed, which interact either with the free end 61 of the plunger spindle, the positioning finger 103, or an edge of the biopsy needle carrier (see
The other system is based on measuring the number of revolutions of the DC motors. In this case, a pickup is mounted on the shaft of the DC motor, which interacts with a photocell mounted on the housing of the DC motor. In this way, the number of revolutions of the motor is measured. Since the DC motors operate with a speed of around 10,000 to 12,000 rpm, depending on the load, and on the other hand the secondary planet transmission arranged at the take-off end which interacts with the spindle drive considerably reduces the number of revolutions, an exact lengthwise control is possible. The lengthwise displacement by the spindle drive is a constant value proportional to the operating speed and is therefore sufficient as a control signal for the lengthwise displacement. In order to precisely determine the position of the cutting sheath 3 as well as the plunger 54 at the start, i.e., after inserting the removable element and closing the housing cover 10, the DC gear motor 58 rotates the plunger 54 until it strikes against the syringe bottom and the DC gear motor 21 brings the drive of the cutting sheath to a zero position by moving the gear 74 until it strikes against the threaded spindle nut 75. (The threaded spindle nut 75 abuts against the gear 74.) From this zero position, the individual steps are then controlled by comparing the settings and the actual values. The necessary cables from the measuring pickup to the electronics are accommodated in the housing, as is the board with the electronic components. A microprocessor arranged inside the housing, under the cover, with the setpoint values stored in it, controls the individual processes.
In order to enable easy insertion of the removable insert unit, the insert aid shown in
The tip of the needle unit of the biopsy device can be placed directly on the tissue being sampled and inserted into the tissue. It can be expedient, however, to first position a coaxial cannula and then introduce the portion of the needle unit (consisting of biopsy needle and cutting sheath) protruding from the hand piece 1 of the biopsy device into the coaxial cannula 125. In this case, one should make sure that, when the vacuum is created for sucking in the tissue sample, no air can get in from the outside into the space between the inner surface of the coaxial cannula and the outer surface of the needle unit. In the coaxial cannula (
The depth of penetration of the biopsy needle unit of the biopsy device is between 20 and 35 mm, depending on the selected size of needle. In general, it is 20 mm. In the case of small breasts or tumors lying just below the skin, the depth of penetration of the biopsy needle is therefore too deep, since the biopsy device is placed directly or by means of the guide roller onto the coaxial cannula and the depth of penetration cannot be changed at the device. The depth of penetration is device-fixed. In order to be able to use the same biopsy device with the same biopsy needle and same depth of insertion and the same, i.e., uniform coaxial cannula with same overall length and less depth of insertion, one or more spacing pieces 129 are placed medially onto the biopsy needle prior to insertion; thus, these lie medially in front of the guide roller mounted in the housing and the proximal end surface 128 of the cap 122. Thus, by introducing spacing pieces or a spacing piece, the depth of penetration can be changed for the same depth of insertion provided in the device.
After inserting the spacing piece, the tip of the biopsy needle in the cocked condition no longer projects slightly from the coaxial cannula, as when no spacing piece is used, but rather lies in the coaxial cannula. The depth of penetration is thus reduced by the length L of the spacing piece (also see
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|U.S. Classification
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|International Classification
|Cooperative Classification
|European Classification


text:
In Diablo 3, every time someone uses an inappropriate word I see a bunch of random characters instead of what they are actually saying. I'm a fan of angry, curse-filled rants. I enjoy seeing the interesting, colorful language of people who are having a hard time in-game. Is there a way to turn off the language filter?
Take the 2-minute tour ×
Arqade is a question and answer site for passionate videogamers on all platforms. It's 100% free, no registration required.
After you are logged into your account select Options -> Social Tab -> Uncheck the box that reads "Mature Language Filter" in the bottom right hand corner.
I think its in Options->Social near the 'allow quick join' setting. Will update the answer once I can login & check.


text:
With their epic quest nearing its end, the Mane 6 reach the Changeling Kingdom and find themselves at the mercy of Queen Chrysalis! A sinister offer threatens to tear the group apart before they can save the day. Will friendship prevail over the Queen's nefarious plan?
Hot Topic exclusive variant cover!
- ©2013


text:
Electric Motor, Power Tool, & Related Repairers
Also called: Electric Motor Winder, Maintenance Technician, Mechanic, Repair Technician
In the military: see titles from the Army, Marine Corps, or Navy.
In the Army: AH-64 Attack Helicopter Repairer; Aircraft Electrician; OH-58D Helicopter Repairer; Observation/Scout Helicopter Repairer (RC); Power Generation Equipment Repairer; Powerline Distribution Specialist (RC); Quartermaster and Chemical Equipment Repairer; Small Arms/Artillery Repairer
In the Marine Corps: AH-64 Attack Helicopter Repairer; Aircraft Electrical Systems Technician, F/A-18; Aircraft Electrical/Instrument/Flight Control Systems Technician, IMA; Basic Utilities Marine; Electrician; Electronics Technician (Nuclear); Mineman; OH-58D Helicopter Repairer; Powerline Distribution Specialist (RC); Small Arms/Artillery Repairer; Towed Artillery Systems Technician
In the Navy: Aviation Electrician's Mate; Aviation Electronics Technician; Construction Electrician Basic; Electrical Motor Rewinder; Electrician's Mate (Nuclear); Electrician's Mate (Submarine); Electrician's Mate Basic; Electronics Technician (Nuclear); Mineman; Sonar Technician (Surface)
- Measure velocity, horsepower, revolutions per minute (rpm), amperage, circuitry, and voltage of units or parts to diagnose problems, using ammeters, voltmeters, wattmeters, and other testing devices.
- Record repairs required, parts used, and labor time.
- Reassemble repaired electric motors to specified requirements and ratings, using hand tools and electrical meters.
Engineering and Technology
Math and Science
Basic Skills
Problem Solving
Hand and Finger Use
Ideas and Logic
Visual Understanding
People interested in this work like activities that include practical, hands-on problems and solutions.
They do well at jobs that need:
You might use software like this on the job:
Analytical or scientific software
Data base user interface and query software
Spreadsheet software
You might like a career in one of these industries:


text:
Gov. Terry Branstad has proposed education reform across the state of Iowa. The proposal includes stipulations such as increasing teacher base pay from $28,000 to $35,000, creating a teacher career ladder and forgiving loans of up to $20,000 of new education graduates teaching in Iowa.
Allowable growth
Over five years, $187 million will be doled out to school districts across the state. As of Tuesday, schools will not receive any money for "allowable growth," a percentage increase per student that helps schools pay for rising prices of paper, electricity and heat.
"Our highest priorority is student achievement. What can we do to increase student achievement? You invest in teachers. Good plan. I'm very supportive of what I'm reading," said Scott. "In the same breath, there are other needs that need to be addressed, which is sustain what we have."
Branstad asked the Iowa House of Representatives to focus their attention on education reform before turning to making an "allowable growth" decision.
However, according to the article "Iowa Gov. Branstad wants education reform by February," by the Sioux City Journal, school districts across Iowa have pointed out they face deadlines to certify their 2014 fiscal budget, and if the Legislature and governor do not reach a level of state aid for schools by March, districts will have to issue layoff notices.
"The single most important factor in student achievement is quality teaching," said Creston High School Principal Bill Messerole.
However, there are many questions being asked locally about the idea of taking teachers out of the classroom.
"Is it advantageous to take our best teachers out of the classroom? I don't have the answer for that," said Messerole. "In theory one of the things I liked, maybe reduced loads for new teachers so they spend more time observing really quality, veteran teachers."
Messerole also said it would be tough to tell how many new teachers might be needed if teachers are being removed from the classroom, because those students still need to be taught.
"Mainly, what we're buying is time: time for that first-year teacher to really get a good experience, time for teachers to collaborate with each other," said Stephens. "And it's not wise to leave elementary classrooms with no one in there, so you have to hire good substitutes to come in and cover and make sure that those lessons that the subs are teaching are good."
One suggestion Scott made was to bring recently-retired master teachers back to mentor new educators instead of taking master teachers out of the classroom.
Into practice
Branstad called for the education reform, a 67-page bill, to be worked out and passed by the end of February.
"I believe that the Legislature has time in the months of January and February to pass significant education reform that still gives them plenty of time then also to indicate additional supplemental funding for education over and above that," the governor told his weekly news conference, according to the Sioux City Journal article.
The reform is meant to make education more competitive with industry and business, especially considering the raise in salary and loan forgiveness.
"I think educators truly need to be compensated more," said Scott. "I'm a firm believer that principals need to spend more time in the classrooms mentoring teachers, coaching teachers, lifting them up, helping them get better at what they do. By principals being in the classroom, it will make a significant difference."
Pull Quote:
"The single most important factor in student achievement is quality teaching." Bill Messerole


text:
Easy Glazed Salmon Recipe
- 1/3 cup packed brown sugar
- 1/4 cup unsweetened pineapple juice
- 2 tablespoons soy sauce
- 4 salmon fillets (6 ounces each)
- Line a 15-in. x 10-in. x 1-in. baking pan with foil; grease the foil. Set aside. In a small bowl, combine the brown sugar, pineapple juice and soy sauce. Place salmon skin side down on prepared pan. Spoon sauce mixture over fish.
- Bake, uncovered, at 350° for 20-25 minutes or until fish flakes easily with a fork, basting frequently with pan juices. Yield: 4 servings.
Full-Bodied White Wine
Enjoy this recipe with a full-bodied white wine such as Chardonnay or Viognier.
Reviews for Easy Glazed Salmon
Sort By :
"This is very good. I do feel like it could benefit from some more seasonings, though, as another reviewer mentioned--some pepper and onion come to mind. The glaze is thin, and so baked into the fish, which was wonderful, but I figured it would be nice to have a thickened glaze to spoon on top of the fish when it was done, as well as on the wild rice blend I cooked to go with the salmon. So when I mixed up the glaze ingredients, I increased all three of them, and after I spooned what was needed onto the salmon on the baking sheet, I put the rest into a small saucepan, along with some pineapple tidbits (I got the juice from their can) and heated it over high heat while the fish was baking to reduce it to a thicker glaze. This was wonderful topping both the salmon and the rice."
"Very good!"
"I have made this recipe many times and changed it up at times this is great! You must try it!"
"Loved it."
"Just made this for dinner tonight. Perfect terriaki glaze. Though it took a little longer than 25 min to cook but my oven sucks. Definitely a keeper."


text:
If Ferrari asked Kimi Raïkkönen for a quote before they announced that their former World Champion was returning to Maranello, they probably wanted him to tell them how much his services would cost second time around.
The notoriously non-committal Finn – ironically world-famous for his "Leave me alone" quote in Abu Dhabi last year – has maintained his usual silence over his return to the team he graced between 2007 and 2009 before announcing that he was doing a Schuey and quitting the sport.
So, for the first time in what we might call F1's modern era, Maranello will boast two World Champions in its line-up. Not since the far-off days of Ascari and Farina in the early Fifties has that been the case. Company president Luca di Montezemolo is on record as saying how much he wanted to avoid having "two roosters in the henhouse", but with three titles between them, not to mention 52 Grand Prix victories, that's exactly what appears to have happened.
But well-respected Ferrari team boss Stefano Domenicali has been quick to play down any suggestions of two bulls locking horns within the Ferrari camp next season.
"At Ferrari, everyone knows the interests of the team come first and only then those of the individual," he insists. "I would only say that the combination of Fernando and Kimi is the best one could have today in Formula 1, in terms of talent, experience, competitive spirit and the ability to move car development forward," he said.
Nor is it a shot in the dark: as well as having known Kimi for three seasons, Ferrari have also recruited James Allison as their technical chief in charge of chassis development, and he worked closely with the Finn at Lotus.
Since the team comes first, let's look at Ferrari's recent performance. By the end of this season it will be five years since the Italian marque last took the coveted Constructors' Championship, and much of that is down to driver contribution.
The man Raïkkönen will replace, Felipe Massa, came famously close to winning the world title in 2008, beaten on the last corner of the last lap by Lewis Hamilton nicking fifth place in Brazil. That was Massa's last F1 victory; since his unfortunate accident in Hungary the following season he has never returned to that outstanding form, and while there has been much sympathy for the Brazilian's plight F1 is a famously unforgiving environment.
Ironically Massa measured up pretty well against Raïkkönen when they were partners at Maranello. While Kimi captured the title in his first Ferrari year, Massa had three wins that season; in 2008 he outscored Raïkkönen six wins to 2.
Against Alonso the stats don't look so good. Since joining Ferrari Alonso has won 11 times, including two this year. In 2010 Fernando scored 252 points, Felipe 144, a difference of 108. Ferrari were 102 points behind title-winners Red Bull.
In 2011 it was Alonso again by 257 points to 118, a huge gap of 139, though it wouldn't have mattered much if Massa had scored as Red Bull won by 275! Last year Alonso racked up 278 points to Massa's 122. That's a gap of 156, and Red Bull won by 'only' 60.
And this year? Alonso sits on 169 points going to Singapore with Massa on 79. The difference is 90 – and Red Bull are 104 ahead. If Vettel has been the dominant driver, our own Mark Webber has made major contributions with nine race wins and points tallies of 242-258-179 in the last three seasons.
This year Mark has scored 51 points more than Massa as he helps Red Bull sprint towards a fourth straight double title success. No wonder the Australian's own name was in the Ferrari frame not so long ago.
Those are the numbers Ferrari expects to see changing dramatically as Alonso and Raïkkönen team up for the next two seasons, especially when everyone starts with a clean slate as the new turbo-charged engine formula comes into play from 2014 onwards.
Since returning to F1 in 2012 with Lotus Renault Raïkkönen has notched up another two wins, in Abu Dhabi last season and right here in Australia at the start of 2013. He has been scrupulously careful not to blame the team for any perceived shortcomings, and generous in his praise when they have gone well.
He knows, however, that another step up is needed. Lotus chief Eric Boullier admitted as much when he said his was still a medium-sized team, one perhaps not quite ready to challenge the current top two of Red Bull and Ferrari, to say nothing of the emergent force that is Mercedes.
But he called the Finn "an amazing racer", a label borne out by Raïkkönen's astonishing sequence of 27 points-scoring finishes for Lotus which ended just a couple of races ago in Belgium.
The step up might have come with his departure for Red Bull, which the rumour mill touted vigorously before the summer break at the same time as they were saying Alonso was another candidate for a drive alongside the all-conquering Sebastian Vettel – something Domenicali castigated as a deliberate attempt to destabilize his own team.
Now the step has come, in theory at least, with a return to the red colours which Raïkkönen flew so successfully a few seasons ago. As a cautionary note, they say you should never go back, and few drivers at the peak of F1 have done that in their time. A relatively recent example came, coincidentally, at Ferrari.
Gerhard Berger claimed 10 victories in his long Grand Prix career. Four of them came in the Austrian's first stint at Maranello from 1987-89. After a spell at McLaren Berger returned to Ferrari in 1993 for another three-year stay. Of the 49 Grands Prix he contested in red second time around, he won just one, an incident-strewn race in Germany in 1994.
But that's history, and it's the immediate future that holds out so much intrigue with this announcement. Will the sparks fly between two of F1's greatest? Or will individual genius combine in pursuit of the greater good?
Think Mansell and Piquet at Williams, think Prost and Senna at McLaren: it hasn't often been the case…