Borrowing life- medicine

What color does carbon monoxide poisoning turn the blood to?

Cherry pink rather than deep red so the victims can look deceptively in good color

What is the body ultimate protection?

The skin

How much of Charles body was burned?

Over 70%

What are autografts?

Self, graft transplanted from one site on the body to another in the same person. They used them in burn patients to prevent fluid losses.

What are allografts?

tissue taken from an unrelated person

What the skin allograft expected to survive? What is this process called?

No usually in 10-14 days the skin will become gray and shrunken and will slough off - this is called a rejection

Who had grafted skin between identical twins?

Dr. James Barrett Brown a plastic surgeon in Saint Louis.

How did burn victims die?

First by suffocation then by dehydration and eventually infection

When was penicillin discovered? From what?

1928 by Alexander Fleming from a substance released by mold and killed bacteria

What happens if you have no eyelids?

You can not blink so you can not keep your eyes moist

How did mass production of penicillin start?

From a moldy cantaloupe in a market in Peoria Illinois which allowed 2.3 million doses to be produced in WWII

Who invented the microscope?

Anton van Leeuwenhoek

What is the technique for tissue culture ?

The tissues were dehydrated then impregnated with paraffin wax then cut into slices of thousandth of mm thick then mounted on glass slides and stained with variety of stains

What is epigenesis?

The theory that individuals develop from instructions written in the unstructured egg rather than enlarging from a preformed entity

What was a famous medical book about the impossibility of transplantation?

The biological basis of individuality by Dr. Leo Loeb.

What was a fad in the field of transplantation?

In Chicago in 1916, Dr. Frank Lydston transplanted slices of testicles into the scrotum of patients to gain sexual prowess ( ridiculous!)

What did the first dialysis machines consist of?

Sausage casing and tomato cans

What is crush syndrome?

body part trapped > 4hrs; toxins build up

And rush through blood vessels. The toxins is released from the muscles. This injures the kidney. This is known now as Rhabdomyolysis. The kidneys could eventually heal is body can survive that period of time

Where are this kidneys located and what are their size?

Fist sized on each side of the spine

Who invented the first dialysis machine

In 1938, William Kolff at the university of Groningen in Nazi occupied Holland

What did kolff use on the other side of the membrane to do dialysis?

Salt water

What is one of the toxins that builds up in a case kidney failure?

Urea

What is heparin?

Chemical substance that prevents clotting

What did heparin help with?

Dialysis

Where did Kolff publish his findings?

In a Scandinavian journal in 1944

What are lymphocytes?

Type of WBC that attack foreign matter and fx as the source of our defense

How did Peter identify rejection when grafting skin from the brother of the burn victim?

He saw blood vessels invading the graft , a sign of inflammation that impaired the healing process

When is inflammation useful?

With it helps fight infection as small blood vessels dilate to increase blood flow to a site

When is inflammation not useful?

When the body becomes confused and attacks itself. With chronic inflammation. Serious conditions can develop like autoimmune diseases.

How does the body attack a tissue perceived foreign?

With inflammatory response

What is the second set phenomenon in the skin graft?

The body rejected the second graft quicker because the immune system has a memory

Who is the father of modern medicine?

Pasteur

Who discovered bacteria?

Pasteur discovered germs . Germen in Latin means offshoot

Who is Elie Metchnikoff?

Russian zoologist Elie Metchnikoff designed studies to show white blood cells assaulting and digesting germs

What are white blood cells?

The army in our body to fight off infections

Where did Peter and Tom Gibson publish their findings of the immune system?

In 1943 in the Journal of Anatomy in an article titled "the Fate of Skin Homografts in Man"

Who also discovered that the skin grafts between identical twins can be done without rejection?

Dr. James Barrett Brown in St. Louis in 1937

What is the key in successful transplantation?

To trick the body to accept a foreign tissue by manipulating the immune system

What is the second set phenomenon known as ?

The acquired immunity

What other types of immunity there is other than acquired?

Innate

How did Joe make eyelids for Charles?

Taking skin from collarbone which replaced slitting the scar contracture around the eyes to let the skin fall on the eyeballs

How did Joe make a nose for Charles ?

He used an ancient technique from Italy in 1500s. They connected the upper arm to the center of the face to keep blood flow nourishing the tissue. Then stalks called pedicles grew from the arm to the face. The the pedicle established its own blood supply and then cut away making a mass of skin that is the nose. A

When was plastic surgery born?

In Germany in 1818 where surgeons reconstructed noses for patients whose nose was destroyed from the use of Mercury when treating syphilis

What was the survivors of the nuclear bombs found to have?

A suppressed immune system

What did the dialysis machine have at the Brigham instead of the old one

Polyethylene tubing and a rotation apparatus to filter the blood

What skin color did patients with kidney disease have?

Yellow tint ( from the toxins)- this is called uremia

What is Bright's Disease?

The other name is glomerulonephritis which is inflammation of the kidney little cups ( glomeruli) that filter the blood. First identified in 1836 in London by a physician called Richard Bright

What could cause kidney failure in young patients?

1- glomerulonephritis

2- chronic pyelonephritis with an issue in the kidney drainage system into the pelvis

3- malformation of the kidneys with many cysts or horseshoe kidneys

What could cause kidney failure in older people?

Hardening of the arteries

What are the symptoms of kidney failure?

Yellow-pasty look, loss of appetite, loss of weight and swollen ankles

Why do you have swollen ankles in kidney failure?

Because you can not excrete excess salt and water

What is dropsy?

The body inflates by pooling with fluid, making you look like a balloon. This happens in kidney disease patients.

Why was Lister surgical paper important? When was is it published?

In 1867. It talked about importance of surgical cleanliness.

What is Ether?

- Inhaled Local Anesthetic used for anesthesia up till 1960s

What was the cadaver preserved in, in the anatomy lab?

Formaldehyde

What was the reason that the patient that Franny operated on ( breast surgery) died?

Pulmonary embolism ( blood clot in lungs) from a clot in a vein in the leg

What is pyloric stenosis?

A condition in which the opening between the stomach and small intestine thickens so then the patient usually a baby has repeated vomiting

What did the boy who had pylori's stenosis and that Franny operated on die from?

The deep anesthesia paralyzed the infant blood vessel reflexes that kept the blood flowing against gravity, up from the legs and lower part of the body to the brain and heart. This is especially important in infants because those reflexes are not strong yet. The brain robbed of blood started to die and with it the drive for respiration. This is the same was, one can die from crucification. That is why after that, laying infants down a wheeled crib became a standard practice.

How did Franny figure out the amount of water in the body?

He used techniques of nuclear physics and injected into a patient a carefully measured dose of heavy water, the non radioactive isotope of hydrogen. When the water was mixed with the body's ordinary water, the dilution of the heavy water would show the body's total water volume

Which medical textbook was a landmark? Author and co-author?

The medical care of the surgical patient because it declared that the surgeon's responsibility is to take care of the whole patient. The author was Franny and he put Margaret Ball as his co-author.

Who pushed the field of anesthesia?

Dr. Harvey Cushing because one of his patients died as he gave too much anesthesia

What was the first attempt to transplant a kidney?

The surgeons attached a kidney to a woman's arm by connecting the artery and the vein of the elbow to the kidney. The kidney worked for few days then was rejected. It supported the patient enough till she recovered.

What is the lymphatic system?

Consists of lymph nodes and lymph vessels that carry lymph (a clear fluid right in antibodies). The spleen, thymus, and the tonsils are made of lymphoid tissue. It supports the immune system by housing and transporting white blood cells to and from lymph nodes. This system also returns fluid that has leaked from the cardiovascular system back into the blood vessels.

What were unknown questions for Joe and Franny in regard to kidney transplantation?

1- would a borrowed kidney remain healthy without its lymphatic supply? Could a transplanted organ function without nerves being attached to its new host ? When a kidney was lifted from one body to another, would the transfer irreparably damage it?

How did Peter explain the difference between identical and fraternal twins to Hugh Donald the vet?

Skin grafting would be successful in identical twins

How did Peter explain the success of skin grafting in identical twins?

The twins shared placentas and blood which allowed them after birth to react to the other's tissue as their own. He proposed that the antigens leaked from the yolk sac of the embryo to another

What are antigens?

foreign molecules that trigger the generation of antibodies. It literally means " the things that generate antagonism

What did Peter postulate about tolerance?

Tolerance could be acquired and changed prior to birth

What body part is free of immune system and can be transplanted without being attacked

The anterior chamber of the eye like the cornea

What is vivisection?

the practice of performing operations on live animals for the purpose of experimentation or scientific research

Who discovered the polio virus and vaccine ?

17 000 monkeys were imported from India to a special farm in South Carolina which allowed John Salk to find the 3 different strains of poliovirus and create the 1954 polio vaccine

Which scientist conduced cruel experiments on animals?

French physiologist Francois Magendie when he was studying the function of the spinal cord

Which book set rules to be followed in animal experiments?

The Handbook for the physiological Laboratory in 1873

Which disease affects both animals and humans? Which scientist worked on the vaccine?

Rabies. Pasteur

When was the first kidney transplant?

In March 1951, Dr. James Scola transplanted a cadaveric kidney into a patient at Springfield Hospital

Which type of suture was utilized in kidney transplantation? Who invented it?

The suture anastomosis by Alexis Carrel

What is hydrocephalus?

a condition in which fluid accumulates in the brain, typically in young children, enlarging the head and sometimes causing brain damage.

How did Don Matson relieve hydrocephalus?

He placed a small plastic tube, a shunt, to drain fluid from the brain to the child's ureter then bladder . This lead to sacrificing one kidney

Where did the Brigham surgeons take kidneys from for their experiments in 1951? Where did they place the kidneys ?

From Don Matson's kids . Kidneys were placed in the thighs.

Who is Dr John Enders?

John Enders and his residents Weller and Robin took kidneys from Matson to grow viruses in tissue culture and then produce vaccines. They were awarded Nobel Prize in 1954

How did Peter induce tolerance in mice?

He delicately injected brown embryos with living cells from one of the white mice

What is tolerance?

Fooling the body to accept foreign cells as "self"

His did Franny find a new way to locate abscesses and tumors?

By using radioactive isotope

What other book did Franny publish?

Metabolic care of the surgical patient

Which journal did Peter publish in and when where that issue had the publication of Watson&Crick on DNA?

Nature in 1953

What are the titles of 2 important articles published by Peter?

1- the use of skin grafting to distinguish between monozygotic or dizygotic twins

2- actively acquired tolerance of foreign cells

How many days did the first patient with kidney transplantation in his thigh survive ? An from what did he die?

175 days. He did not die from rejection but they found that the arteries of the kidney graft had hardened

What are the 3 conditions needed for a successful transplant?

1- they had to have a privileged situation to prevent the antibodies from getting at the grafted kidney

2- they would have to change the tissue of the kidney itself so it was not antigenic

3- they would have to change the recipient body so it could not or would not make antibodies

Which situation could answer all 3 conditions for a successful transplantation?

Identical twins

Where was the dialysis machine connected to?

To an artery and a vein in the arm

How big was the dialysis machine in old day?

Five feet long and four feet high

Why was Richard in psychosis ?

Because of the toxins

How did Joe make sure that Ronald and Richard are identical twins?

Birth records that they share the same placentas, fingerprints and then skin transplants

How did the doctors tell Ronald the life expectancy of someone with one kidney? What was it?

From actuarial tables from insurance companies. No increased risk of death.

How often is a person with one kidney? What happened next?

1 in 1000- either born that way or lost it in surgery or car accident.

Franny convinced Joe to agree with Dr. Merrill

What did Joe and Dr. Merrill disagree on before the twin surgery?

Joe wanted to remove the native kidneys and Dr. Merrill wanted to keep them

What kind of anesthesia did Richard have?

A spinal

What other surgeries did Richard have after the transplant kidney surgery?

He had surgeries to take out his native kidneys

What are lymphocytes? What is the size?

type of white blood cell that helps with making weapons to attack foreign bodies. The diameter is 3.5 micra

How much did Franny think that the total mass of the cells weigh in the body?

55 pounds