CA1217822A - Trigger for therapeutic shock waves - Google Patents
Trigger for therapeutic shock wavesInfo
- Publication number
- CA1217822A CA1217822A CA000414535A CA414535A CA1217822A CA 1217822 A CA1217822 A CA 1217822A CA 000414535 A CA000414535 A CA 000414535A CA 414535 A CA414535 A CA 414535A CA 1217822 A CA1217822 A CA 1217822A
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- Canada
- Prior art keywords
- trigger
- pulse
- channels
- signal
- instrument according
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
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- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
Abstract
ABSTRACT OF THE DISCLOSURE:
A trigger instrument for triggering shock waves for the contact-free comminution of concretions, characterised by a plurality of channels for measuring various periodic body functions, each having: a measured value pick-up for one of the body functions, a circuit which obtains a trigger pulse from an extreme value of a measuring signal supplied by the measured value pick-up, and an adjustable delay device which emits the trigger pulse with a timing delay. An AND-gate is provided to which the outputs of all measuring channels are connected and which, upon simultaneous arrival of trigger pulses from all channels, delivers to the shock wave source a signal pulse via a manually actuated release switch.
A trigger instrument for triggering shock waves for the contact-free comminution of concretions, characterised by a plurality of channels for measuring various periodic body functions, each having: a measured value pick-up for one of the body functions, a circuit which obtains a trigger pulse from an extreme value of a measuring signal supplied by the measured value pick-up, and an adjustable delay device which emits the trigger pulse with a timing delay. An AND-gate is provided to which the outputs of all measuring channels are connected and which, upon simultaneous arrival of trigger pulses from all channels, delivers to the shock wave source a signal pulse via a manually actuated release switch.
Description
The invention relates to a triyger for therapeutic acoustic shock waves, for instance for comminuting kidney stones.
An instrument Eor the contactless comminution of concretions in bodies of living tissue ~y means of shock waves is known (note U.S. Patent No. 3,942,531). In this instrument, elec-tric discharges along a submerged spark gap generate acoustic shock waves in a focusing chamber, outside the body, the shock waves being focused on the concretion and comminuting it. These shock waves pass through the body tissue without damaging it. However, extrasystoles may be triggered in the stimulative phase of the heartbeat.
Accordingly, the heart rhythm can be disturbed in patients with circulatory problems. In that case adequate circulation of the blood no longer will be ensured. Moreover, care must be taken when selecting the trigger time that the coordi-nates of the target, for instance the kidney - which are periodically changing due to breathing - shall be as constant as possible at the time of the shock wave triggering in order to achieve a high impact probability.
An object of the present invention is to provide an instrument correlating the trigger time of the shock wave for example to the heart action in such a manner that the heart rhythm cannot be disturbed. The present invention also relates to a method of comminuting concrements in the body of a human being by shock waves.
This problem is solved by the invention by means of an instrument triggering the shock wave by the QRS peak of the EKG, or by triggering with a selective time-delay thereafter.
One of the advantages of the present invention is that shock waves can be appli~ed to patients with impaired blood circulation and that this group of patients also can be spared surgical intervention. The physician is relieved, 9;~
t~
by the automatic time correlation with the heartbeat and/or further body functions, fxom the task of matching the shock wave application to the body rythms. This permits avoidance of erroneous steps.
According to the present invention there is provided a trigger instrument for triggering shock waves for the con-tact-free communication of concretions, characterised by a plurality of channels for measuring various periodic body functions, each having:
a) a measured value pick-up for one of the body functions, b) a circuit which obtains a trigger pulse from an extreme value of a measuring signal supplied by the measured value pick-up, c~ an adjustable delay device which emits the trigger pulse with a timing delay, and by an AND-gate to which the outputs of a]l measuring channels are connected and which, upon simultaneous arri~al of trigger pulses from all channels, delivers 20 to the shock wave source a signal pulse via a manually actuated release switch.
Preferably, there are two signal channels each for a body function.
Preferably, the AND-gate has two inputs, which 25 corelates two input signals, coming from said two signal channels.
Preferably, the AND-gate has an output which is zero or logic low if there is no pulse or only one pulse at the inputs and said AND-gate has an output 30 which is a pulse or logic high if there are pulses at both inputs at the same moment, so that an output pulse is only available at said moment, when the time delay after one QRS peak of an EKG probe forming said test-value pick-up corresponds with one phase of exhaled state at a time the heartbeat is not vulnerable and 3~Z~7~
the motion of the body, induced by breathing, is zero.
The measured value pick-up may be an EKG
probe, the extreme value belng the QRS peak of the EKG, ot is may be a respirometer, a phase of the exhaled state being the extreme value.
Preferably, the trigger instrument may include means whereby the circuit extracts a trigger pulse from every second, third, etc. extreme value~
In a preferred aspect a first one of said channels may include a measured value pick up for an EKG signal, and a second one of the channels may include a measured value pick up for respiration, a coincidence circuit being provided for responding to an extreme value in the EKG signal as pickedup through the first channel and to an exhaling state as picked up by the pick up of said second channel~ to obtain the trigger signal in response to a coincidence.
Preferably, a danger free trigger time for applying acoustic shock waves is at a predetermined time after said extreme value.
Preferably, the adjustable time-delay and the circuit receiving a pulse and producing another pulse at a predetermined time, are combined in a pulse generator, and the switch is open most of the time and interrupts the signal channel, a signal pulse being transmitted to the shock wave upon closure of said switch.
With the present trigger instrument the method of comminuting concrements in the body of a human by means of therapeutic acoustic shock waves comprises the steps of:
picking up a periodic body function and extracting from a picked up value a particular, perio-dically recurring indication;
adjustably delaying a representation of said indication;
providing for triggering a shock wave in direct xesponse to said delayed representation and in dependence upon a manual release when made; and providing said manual release to obtain said trigge.ring.
According to one aspect of the method there is provided a method of generating shock waves for comminuting concrements in the body of a human being, comprising the steps of:
picking up a plurality of periodic body functions;
extracting from each representation as resulting from said picking up particular recurring values;
adjustably delaying each said pick-up value;
combining in a logic coincidence function the delayed particular picked~up values for establishing manually releasing said trigger pulse for triggering the generation of a shock wave for initiating said comminuting.
The invention will be better understood b~ the description that follows of a preferred embodiment thereof, made with reference to the appended drawings wherein:
Figure 1 shows the EKG voltages as a function of time for normal heartbeat, ar~d Figure 2 is a block diagram of an instrument with further automation by taking into account a second body function, in this case breathing.
Referring to Figure 1, the terms P,Q, R, S, and T
of the wave function are conventional in medicine. The steepest rise occurs at the leading edge of the QRS peak (Figure 1). Point 2 shows a danger-free trigger time for applying acoustic shock waves. The EKG is recorded in known manner, and a trigger pulse is obtained in known manner from the leading edge of QRS peak and fed into a delay system.
This system is adjustable within the range from 0 to lO00 msec and~ depending on the time preselected by the physician (distance 1-2), delivers a trigger pulse to a spark gap, which is ignited and then generates an acoustic shock wave.
Referring to Figure 2, two test-signal pick ups, pick up 3 for the EKG, and pick up 4 (respirometer) for the breathing motion, feed their test values each to a pulse generator 5, 6. These generators can be so set that they will deliver a pulse for a specific phase of the test values, for instance 10 msec after the occurrence of the QRS peak or at the time of the breathing pause (phase of the exhalded state). The outputs of the pulse generators are connected to the inputs of an A~D gate 7. The output of the gate 7 is supplied through a manual switch 8 to a spark gap pertaining to a shock wave generator by means of which a concretion in the body of a patient is comminuted. The fJ~4 shock wave generator includes additionally an elliptical, liquid filled coupling device as shown in the above indentified patent 3,942,531.
Each of the pulse generators 5 and 6 as shown schematically in Fig. 2 usually comprises a circuit for extracting an extreme value and a time-delay. The circuit for extracting the extreme value searches and finds the extrerne value of the input body function and produces an electrical pulse at the moment of the extreme value and the time-delay receives one pluse and produces another pulse at a predetermines desired time t, i.e. the time between points 1 and 2 in Fig. 1.
A trigger pulse therefore arrives at the spark gap only when:
a) the physician keeps the switch 8 closed, b) the breathing motion is nul (phase of the exhaled state3, and c) the QRS peak of the EKG has just occurred.
Further body functions may be taken into account by further parallel signal channels, by the rapidly succeed-ing triggering of several shock waves, by rapidly succeeding trigger pulses within one period, and by extracting the trigger pulse only from every second, third, etc. extreme value.
With only one channel, a logic combination means 7, i.e. and AND-Gate is not necessary because thexe is nothing to correlate with.
The realisation for two body functions comprises two channels with the elements shown in Fig. 2 and as explained above, and with the AND-Gate 7 which correlates the two input signals.
The output of the AND-Gate 7, is zero (logic low) if there is no pulse or only one pulse at the inputs and its output is a pulse (logic high) if there are pulses at the both ~2~7~
inputs at the same moment. So one can get an output pulse only at that moment, when the time delay t after one QRS-peak corresponds with one phase of exhaled state (= tirne delay zero after the extreme value of respiration). At this time the heartbeat is not vulnerable and the motion of the body -induced by breathing - is zero.
If it is desired or necessary to correlate a third body function, then a third signal/channel is provided and the AND-Gate 7 with two inputs is replaced by an AND-Gate with 3 inputs.
It will be obvious to those skilled in the art that many modifications may be made within the scope of the present invention without departing from the spirit thereof, and the invention includes all such modifications.
An instrument Eor the contactless comminution of concretions in bodies of living tissue ~y means of shock waves is known (note U.S. Patent No. 3,942,531). In this instrument, elec-tric discharges along a submerged spark gap generate acoustic shock waves in a focusing chamber, outside the body, the shock waves being focused on the concretion and comminuting it. These shock waves pass through the body tissue without damaging it. However, extrasystoles may be triggered in the stimulative phase of the heartbeat.
Accordingly, the heart rhythm can be disturbed in patients with circulatory problems. In that case adequate circulation of the blood no longer will be ensured. Moreover, care must be taken when selecting the trigger time that the coordi-nates of the target, for instance the kidney - which are periodically changing due to breathing - shall be as constant as possible at the time of the shock wave triggering in order to achieve a high impact probability.
An object of the present invention is to provide an instrument correlating the trigger time of the shock wave for example to the heart action in such a manner that the heart rhythm cannot be disturbed. The present invention also relates to a method of comminuting concrements in the body of a human being by shock waves.
This problem is solved by the invention by means of an instrument triggering the shock wave by the QRS peak of the EKG, or by triggering with a selective time-delay thereafter.
One of the advantages of the present invention is that shock waves can be appli~ed to patients with impaired blood circulation and that this group of patients also can be spared surgical intervention. The physician is relieved, 9;~
t~
by the automatic time correlation with the heartbeat and/or further body functions, fxom the task of matching the shock wave application to the body rythms. This permits avoidance of erroneous steps.
According to the present invention there is provided a trigger instrument for triggering shock waves for the con-tact-free communication of concretions, characterised by a plurality of channels for measuring various periodic body functions, each having:
a) a measured value pick-up for one of the body functions, b) a circuit which obtains a trigger pulse from an extreme value of a measuring signal supplied by the measured value pick-up, c~ an adjustable delay device which emits the trigger pulse with a timing delay, and by an AND-gate to which the outputs of a]l measuring channels are connected and which, upon simultaneous arri~al of trigger pulses from all channels, delivers 20 to the shock wave source a signal pulse via a manually actuated release switch.
Preferably, there are two signal channels each for a body function.
Preferably, the AND-gate has two inputs, which 25 corelates two input signals, coming from said two signal channels.
Preferably, the AND-gate has an output which is zero or logic low if there is no pulse or only one pulse at the inputs and said AND-gate has an output 30 which is a pulse or logic high if there are pulses at both inputs at the same moment, so that an output pulse is only available at said moment, when the time delay after one QRS peak of an EKG probe forming said test-value pick-up corresponds with one phase of exhaled state at a time the heartbeat is not vulnerable and 3~Z~7~
the motion of the body, induced by breathing, is zero.
The measured value pick-up may be an EKG
probe, the extreme value belng the QRS peak of the EKG, ot is may be a respirometer, a phase of the exhaled state being the extreme value.
Preferably, the trigger instrument may include means whereby the circuit extracts a trigger pulse from every second, third, etc. extreme value~
In a preferred aspect a first one of said channels may include a measured value pick up for an EKG signal, and a second one of the channels may include a measured value pick up for respiration, a coincidence circuit being provided for responding to an extreme value in the EKG signal as pickedup through the first channel and to an exhaling state as picked up by the pick up of said second channel~ to obtain the trigger signal in response to a coincidence.
Preferably, a danger free trigger time for applying acoustic shock waves is at a predetermined time after said extreme value.
Preferably, the adjustable time-delay and the circuit receiving a pulse and producing another pulse at a predetermined time, are combined in a pulse generator, and the switch is open most of the time and interrupts the signal channel, a signal pulse being transmitted to the shock wave upon closure of said switch.
With the present trigger instrument the method of comminuting concrements in the body of a human by means of therapeutic acoustic shock waves comprises the steps of:
picking up a periodic body function and extracting from a picked up value a particular, perio-dically recurring indication;
adjustably delaying a representation of said indication;
providing for triggering a shock wave in direct xesponse to said delayed representation and in dependence upon a manual release when made; and providing said manual release to obtain said trigge.ring.
According to one aspect of the method there is provided a method of generating shock waves for comminuting concrements in the body of a human being, comprising the steps of:
picking up a plurality of periodic body functions;
extracting from each representation as resulting from said picking up particular recurring values;
adjustably delaying each said pick-up value;
combining in a logic coincidence function the delayed particular picked~up values for establishing manually releasing said trigger pulse for triggering the generation of a shock wave for initiating said comminuting.
The invention will be better understood b~ the description that follows of a preferred embodiment thereof, made with reference to the appended drawings wherein:
Figure 1 shows the EKG voltages as a function of time for normal heartbeat, ar~d Figure 2 is a block diagram of an instrument with further automation by taking into account a second body function, in this case breathing.
Referring to Figure 1, the terms P,Q, R, S, and T
of the wave function are conventional in medicine. The steepest rise occurs at the leading edge of the QRS peak (Figure 1). Point 2 shows a danger-free trigger time for applying acoustic shock waves. The EKG is recorded in known manner, and a trigger pulse is obtained in known manner from the leading edge of QRS peak and fed into a delay system.
This system is adjustable within the range from 0 to lO00 msec and~ depending on the time preselected by the physician (distance 1-2), delivers a trigger pulse to a spark gap, which is ignited and then generates an acoustic shock wave.
Referring to Figure 2, two test-signal pick ups, pick up 3 for the EKG, and pick up 4 (respirometer) for the breathing motion, feed their test values each to a pulse generator 5, 6. These generators can be so set that they will deliver a pulse for a specific phase of the test values, for instance 10 msec after the occurrence of the QRS peak or at the time of the breathing pause (phase of the exhalded state). The outputs of the pulse generators are connected to the inputs of an A~D gate 7. The output of the gate 7 is supplied through a manual switch 8 to a spark gap pertaining to a shock wave generator by means of which a concretion in the body of a patient is comminuted. The fJ~4 shock wave generator includes additionally an elliptical, liquid filled coupling device as shown in the above indentified patent 3,942,531.
Each of the pulse generators 5 and 6 as shown schematically in Fig. 2 usually comprises a circuit for extracting an extreme value and a time-delay. The circuit for extracting the extreme value searches and finds the extrerne value of the input body function and produces an electrical pulse at the moment of the extreme value and the time-delay receives one pluse and produces another pulse at a predetermines desired time t, i.e. the time between points 1 and 2 in Fig. 1.
A trigger pulse therefore arrives at the spark gap only when:
a) the physician keeps the switch 8 closed, b) the breathing motion is nul (phase of the exhaled state3, and c) the QRS peak of the EKG has just occurred.
Further body functions may be taken into account by further parallel signal channels, by the rapidly succeed-ing triggering of several shock waves, by rapidly succeeding trigger pulses within one period, and by extracting the trigger pulse only from every second, third, etc. extreme value.
With only one channel, a logic combination means 7, i.e. and AND-Gate is not necessary because thexe is nothing to correlate with.
The realisation for two body functions comprises two channels with the elements shown in Fig. 2 and as explained above, and with the AND-Gate 7 which correlates the two input signals.
The output of the AND-Gate 7, is zero (logic low) if there is no pulse or only one pulse at the inputs and its output is a pulse (logic high) if there are pulses at the both ~2~7~
inputs at the same moment. So one can get an output pulse only at that moment, when the time delay t after one QRS-peak corresponds with one phase of exhaled state (= tirne delay zero after the extreme value of respiration). At this time the heartbeat is not vulnerable and the motion of the body -induced by breathing - is zero.
If it is desired or necessary to correlate a third body function, then a third signal/channel is provided and the AND-Gate 7 with two inputs is replaced by an AND-Gate with 3 inputs.
It will be obvious to those skilled in the art that many modifications may be made within the scope of the present invention without departing from the spirit thereof, and the invention includes all such modifications.
Claims (10)
1. A trigger instrument for triggering shock waves for the contact-free comminution of concre-tions, characterised by a plurality of channels for measuring various periodic body fonctions, each having:
a) a measured value pick-up for one of the body functions, b) a circuit which obtains a trigger pulse from an extreme value of a measuring signal supplied by the measured value pick-up, c) an adjustable delay device which emits the trigger pulse with a timing delay, and by an AND-gate to which the outputs of all measuring channels are connected and which, upon simultaneous arrival of trigger pulses from all channels, delivers to the shock wave source a signal pulse via a manually actuated release switch.
a) a measured value pick-up for one of the body functions, b) a circuit which obtains a trigger pulse from an extreme value of a measuring signal supplied by the measured value pick-up, c) an adjustable delay device which emits the trigger pulse with a timing delay, and by an AND-gate to which the outputs of all measuring channels are connected and which, upon simultaneous arrival of trigger pulses from all channels, delivers to the shock wave source a signal pulse via a manually actuated release switch.
2. A trigger instrument according to claim 1, wherein there are two signal channels each for a body function.
3. A trigger instrument according to claim 2, wherein said AND-gate has two inputs, which correlates two input signals, coming from said two signal channels.
4. A trigger instrument according to claim 3, wherein said AND-gate has an output which is zero or logic low if there is no pulse or only one pulse at the inputs and said AND-gate has an output which is a pulse or logic high if there are pulses at both inputs at the same moment, so that an output pulse is only available at said moment, when the time delay after one QRS peak of an EKG probe forming said test-value pick-up corresponds with one phase of exhaled state at a time the heartbeat is not vulnerable and the motion of the body, induced by breathing is zero.
5. A trigger instrument according to claim 1 or 2, in which the measured value pick up is an EKG probe, the extreme value being the QRS
peak of the EKG.
peak of the EKG.
6. A trigger instrument according to claim 1 or 2, in which the measured value pick-up is a respi-rometer, a phase of the exhaled state being the extreme value.
7. A trigger instrument according to claim 1 or 2, including means whereby said circuit extracts a trigger pulse from every second, third, etc. extreme value.
8. A trigger instrument according to claim 2, wherein a first one of said channels includes a measured value pick up for an EKG signal, and a second one of the channels includes a measured value pick up for respiration, a coincidence circuit being provided for responding to an extreme value in the EKG signal as picked up through the first channel and to an exhaling state, as picked up by the pick up of said second channel, to obtain the trigger signal in response to a coincidence.
9. A trigger instrument according to claim 1, 2 or 8, wherein a danger-free trigger time for applying acoustic shock waves is at a predetermined time after said extreme value.
10. A trigger instrument according to claim 1, wherein said adjustable time-delay and said circuit receiving a pulse and producing another pulse at a pre-determined time, are combined in a pulse generator, and said switch is open most of the time and interrupts the signal channel, a signal pulse being transmitted to the shock wave upon closure of said switch.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| DE19813146623 DE3146623A1 (en) | 1980-12-10 | 1981-11-25 | Novel phenylalkylamines, their preparation and their use as medicaments |
| DEP3146628.1-35 | 1981-11-25 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1217822A true CA1217822A (en) | 1987-02-10 |
Family
ID=6147122
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000414535A Expired CA1217822A (en) | 1981-11-25 | 1982-10-29 | Trigger for therapeutic shock waves |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA1217822A (en) |
-
1982
- 1982-10-29 CA CA000414535A patent/CA1217822A/en not_active Expired
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Legal Events
| Date | Code | Title | Description |
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| MKEX | Expiry |