DUSSELDORF, Germany — Among the 4,800 medical technology exhibitors at Medica 2007 are giants of imaging, diagnostics, prosthetics, implantable devices and surgical equipment.

It becomes reassuring to see these expected over-extended exhibitions from the familiar brands after passing acre upon acre of not only unknown but unexpected companies from around the world.

Yet both the magic and the madness of the world's largest medical trade show are the myriad medium and small manufacturers seizing the opportunity to display products addressing every conceivable need in the medical industry from scrub rooms to outpatient surgical suites, from single-use disposables to titanium scalpels and saws that will last a lifetime of use.

The 137,000 delegates from 120 countries crowding every square meter of the aisles include distributors, hospital procurement executives, contract manufacturers, materials suppliers, product developers and even, occasionally, medical personnel such as doctors and nurses.

The most startling sight across the 20 cavernous exhibition halls of the D sseldorf Messe is a 10-foot by 15-foot space filled with three park benches and a couple of potted plants, apparently the only booth space that the organizers failed to sell.

With ceremony and a bit of crowd-pleasing theatrics, Compras Industriales Sociedad An nima (CISA; Lucca, Italy) unveiled at Medica a revolution in hospital steam sterilization with Aquazero, a batch sterilizer unit that reduces by 95% the volume of water required.

The company expects a strong uptake in regions such as the southwest United States, southern Europe, and the arid countries of the Middle East and central Asia sensitive to water usage.

For regions where water is abundant the market opportunity is a reduction in the chemical pre-treament of water used by traditional sterilizations units and a positioning for environmental responsibility. Aquazero's positioning against competition also includes reduced unit cost for sterilization through shorter processing time.

Iyad Alamleh, international sales manager of CISA, said water is precious, increasingly expensive for hospitals and it varies widely throughout the world, being drawn from sea water in some regions, and deep wells or rivers in other regions.

"Water can be too hot, too hard, or both, and in all cases requires further treatment," requiring an additional expense and adding to the environmental footprint of a hospital, Alamleh said.

Eros de Pian, director of product development, said a typical sterilization cycle requires 15 liters of water per minute and that a single cycle runs 20 minutes, resulting in a water consumption rate of 300 liters (79.25 gallons) per sterilization batch. Hospitals running an industry average of 10 cycles per day will use 792.5 gallons.

Where hospital sterilization units use water to create a vacuum to seal the batch for the final sterilization, Aquazero uses water only for generating steam reducing water consumption to just 5% of a traditional cycle.

De Pian said the CISA revolution was to replace the water vacuum with an air pump to seal the surgical instruments and medical equipment in the sterilization chamber.

"It has not been done before because there has not been a sensitivity to use of resources," de Pian told Medical Device Daily, adding, "The technology is not quite as simple as switching two pumps."

He also said Aquazero is a technology as well as a product, which means it can be retrofitted to upgrade existing sterilization equipment.

Two portable devices for use in hospitals and managed care facilities, rather than at-home or personal use, were launched at Medica by SPO Medical (Simi Valley, California).

The products have been granted CE mark for distribution in the European Union and will be commercially available in 1Q08.

The PulseOx 6000, a finger device, and the hand-held PulseOx 6100 device, are designed for and use a novel technology called Reflective Pulse Oximetry (RPO) that reduces power consumption by 90% while providing instantaneous readings for blood oxygen saturation and heart rate.

"These types of devices are widely distributed in the market but these are the only ones using RPO and the resulting low power usage is the novelty and a significant differentiator," said SPO President/CEO Michael Braunold.

Oximetry monitoring devices using a finger-insertion sleeve pass a light through the width of the finger and detect the resulting light intensity to deliver data on vital signs for monitoring of patients.

SPO's technology is based on placing a detector on the same side of the finger sleeve as the light emitter, picking up the intensity from a reflection just a few millimeters deep.

Power demand on the battery is one-50th of standard readers, resulting in a battery life of up to 1,000 hours, compared to 18 to 24 hours for other professional models for oxygen saturation and heart rate used routinely by caregivers monitoring patients with, for example, chronic asthma, chronic obstructive pulmonary disease or heart disease.

"We use a military-spec dry lithium battery that is half the length of a standard AA battery," said Braunold.

The two new PulseOx models also feature a new SPO technology called AutoSpot that measures the intensity of blood profusion to identify poor blood flow.

The larger PulseOx 6100 device has a memory capacity sufficient to track and store vital signs for up to 10 patients in a care area.

SPO grew from $1.8 million in revenues in 2005 to $3.7 million in 2006 and Braunold said the company has turned in sales of $4.2 million for the first three quarters of 2007. The lead product is the PulseOx 5500 which marked 100,000 unit sales earlier this year.

Future features for the medical professional PulseOx models will include wireless transfer of patient data and synchronization with patient identification systems used in care settings, most likely through bar code readers.

Braunold told MDD he also expects to grow SPO beyond its medical base to consumer-oriented products "using our core technologies in areas not yet maximized as we see it." As an example he said current monitors for runners require wearing a belt and that SPO technology could eliminate this cumbersome feature.