Posts Tagged ‘surgery’


Female burial from near Bologna Italy (c. 7th c AD)

by Kristina Killgrove

An early Medieval grave near Bologna, Italy, was revealed to contain an injured pregnant woman with a fetus between her legs. Based on the positioning of the tiny bones, researchers concluded this was a coffin birth, when a baby is forcibly expelled from its mother’s body after her death. The pregnancy and the woman’s head trauma may also be related.

The burial, dating to the 7th-8th century AD, was found in the town of Imola in northern Italy in 2010. Because the adult skeleton was found face-up and intact, archaeologists determined it to be a purposeful burial in a stone-lined grave. The fetal remains between her legs and the injury to her head, however, triggered an in-depth investigation, which was recently published in the journal World Neurosurgery by researchers at the Universities of Ferrara and Bologna.

Based on the length of the upper thigh bone, the fetus was estimated to be about 38 weeks’ gestation. The baby’s head and upper body were below the pelvic cavity, while the leg bones were almost certainly still inside it. This means it was positioned like a near-term fetus: head down in preparation for birth. But it also means that the fetus was likely partially delivered.

Although rare in the contemporary forensic-medical literature and even more so in the bioarchaeological record, this appears to be a case of post-mortem fetal extrusion or coffin birth. Bioarchaeologist Siân Halcrow of the University of Otago explains that, in the case of the death of a pregnant woman, sometimes the gas that is created during normal decomposition builds up to such an extent that the fetus is forcibly expelled.

The actual mechanism of coffin birth is somewhat less understood, however. “The cervix shouldn’t relax with death after rigor mortis disappears,” Dr. Jen Gunter, a San Francisco Bay area OB/GYN, says. “I suspect that what happens is the pressure from the gas builds up, and the dead fetus is delivered through a rupture – it basically blows a hole through the uterus into the vagina, as the vagina is much thinner than the cervix.”

This example of coffin birth is interesting from an archaeological standpoint, but the state of the mother’s health makes it completely unique: she had a small cut mark on her forehead and a 5 mm circular hole next to it. Taken together, these are suggestive of trepanation, an ancient form of skull surgery. Not only was the pregnant woman trepanned, but she also lived for at least a week following the primitive surgery.

In the World Neurosurgery article, the Italian researchers proposed a correlation between the mother’s surgery and her pregnancy: eclampsia. “Because trepanation was once often used in the treatment of hypertension to reduce blood pressure in the skull,” they write, “we theorized that this lesion could be associated with the treatment of a hypertensive pregnancy disorder.”

Eclampsia is the onset of seizures in a pregnant woman with preeclampsia (high blood pressure related to pregnancy) and, particularly in the time periods prior to modern medicine, was likely a common cause of maternal death. A pregnant woman suffering in early Medieval times from high fevers, convulsions, and headaches may very well have been recommended trepanation as a cure.

“Given the features of the wound and the late-stage pregnancy,” the authors note, “our hypothesis is that the pregnant woman incurred preeclampsia or eclampsia, and she was treated with a frontal trepanation to relieve the intracranial pressure.”

If the researchers’ conclusions are correct, the mother’s condition was not cured by the cranial surgery and she was buried, still pregnant, in a stone-lined grave. As her body decomposed, her deceased fetus was partially extruded in a coffin birth. Halcrow, however, cautions that this may not be the best explanation. “In this instance,” she says, “the woman could just as likely have died as the result of normal complications from childbirth.”

Whether or not the trepanation and pregnancy are linked, Halcrow does note that “it is pleasing to see a study that is focused on maternal and infant mortality and health in the past, because this subject is often overlooked.” The unique case of the demise of a pregnant woman soon after invasive skull surgery is unparalleled in the archaeological record and therefore important for our understanding of ancient health and disease.

https://www.forbes.com/sites/kristinakillgrove/2018/03/23/pregnant-medieval-woman-gave-birth-in-grave/#17697bc81663

by AVI ASHER-SCHAPIRO

Earlier this year, a Syrian American orthopedic surgeon was shopping with his two toddlers at a Walmart in Grand Rapids, Michigan, when he heard the familiar ping of a notification from WhatsApp, the encrypted messaging service: A teenager had been shot in the leg and the bullet had passed straight through his tibia. The fractured bone punctured his skin like a spear. Although it was the surgeon’s day off, he took the call—as an expert in complex bone operations, this was his specialty.

But this was no ordinary case. His patient was over 6,000 miles away, awaiting care in a makeshift medical clinic in Madaya, a town in Syria some 28 miles from Damascus. The clinic is only a 45-minute drive from Damascus Hospital, but it might as well be on the other side of the world. Madaya, a rebel-held town controlled by the Islamist group Ahrar al-Sham, has been held under siege by Hezbollah, which is fighting on behalf of the Syrian government, since last July. Hezbollah won’t let anything in or out of the town; it was a Hezbollah fighter, locals say, who shot the teenager in the leg.

At the Madaya clinic that day, two men were on duty: a 25-year-old who had been a first-year dental student when the Syrian civil war broke out in 2011, and a veterinarian in his mid-40s. Gangrene had begun to spread down the patient’s leg, and the dental student, in a series of frantic texts, was asking the surgeon in Michigan what to do. As he walked through the parking lot of the Walmart, the surgeon picked up the phone and called the dental student, guiding him through the steps: Immediately load the patient up with antibiotics. Scrub the wound. Clear away as much dead tissues as possible without agitating the patient. Splint the leg.

“Any other call I would have ignored,” the surgeon admitted to me when we spoke in early August. But he knew that the dental student had nowhere else to turn. He is the only orthopedic surgeon in the “Madaya Medical Consultants,” a group composed of over two dozen, mostly Syrian American doctors, whose specialties include pediatrics, obstetrics, and pulmonology. They meet, digitally, in a WhatsApp chat room that supports the Madaya clinic around the clock. Most of the doctors in the group quoted in this story asked not to be identified, for fear of endangering their families in Syria. Rajaai Bourhan, a resident of Madaya, introduced me to the Madaya clinicians, whose identities I’ve also left anonymous for similar reasons.

Throughout Syria, more than 500,000 people are now under siege. The vast majority are penned in by pro-government fighters, their survival hinging on the medical know-how of the doctors, nurses, or medical students who happen to be trapped with them. In clinics like the one in Madaya, medical expertise is increasingly hard to come by, and remote medicine is often the only way patients with complex ailments can receive a semblance of care.

In Madaya, a year-long blockade enforced by a series of Hezbollah checkpoints, backed up by deadly minefields, has separated its 40,000 civilians from the rest of the country. The town hasn’t received a humanitarian-aid convoy since May, and only the most gravely injured or sick are allowed safe passage out. These evacuations require complex negotiations with rebels in other parts of Syria, in a high-stakes human trade.

This places a tremendous burden on the Madaya clinicians, the town’s two remaining full-time medical workers. Neither man has ever set foot in a medical school. The town’s most-skilled medical practitioner, a nurse with a background in anesthesiology, managed to escape last spring after receiving death threats.

But even the stifling siege can’t keep out wi-fi, which permeates the town thanks to a cluster of nearby cell-phone towers operated by Syriatel, the Syrian cellphone giant owned by Rami Makhlouf, President Bashar al-Assad’s cousin. In February 2016, a pulmonologist in Indiana who grew up outside Madaya realized he could use that wi-fi to smuggle medical advice past the blockade. During the winter of 2016, Madaya’s food stores emptied out. Dozens starved to death, and the health clinic swelled with malnourished patients. As the body count rose, the pulmonologist—a board member of the Syrian American Medical Society (SAMs), a humanitarian organization staffed by Syrian American doctors—grew increasingly desperate to boost the capacity of the town’s small clinic.

“It was the only way I could think of to help,” the pulmonologist told me recently. SAMs runs similar telemedicine programs in other parts of Syria, but Madaya is one of the only besieged areas without any trained doctors. After the anesthesiologist nurse fled, he knew the clinic would need more help than he alone could provide.

In February, the pulmonologist wrote an SOS on his Facebook page (he’s shared the posting, but asked me not to make it public since it includes names of doctors who want to remain anonymous) asking Arabic-speaking doctors to join a WhatsApp chat room that would become Madaya Medical Consultants. Within 24 hours of posting the message, over two dozen doctors joined, he recalled. Not wanting to overcrowd the group, he eventually started turning people down.

The dental student remembered the first time the doctors in the WhatsApp group helped him make a diagnosis. The day after the pulmonologist introduced him to the group, a child, whose body was body swollen and misshapen, was brought into the clinic. One of the group’s pediatricians helped identify the patient’s ailment as kwashiorkor, a disease brought on by extreme protein deficiency. First identified during a famine in West Africa in 1935, its name comes from a Ghanaian term for a child whose mother does not have enough breast milk to feed it. To treat the condition, a pediatrician in Chicago helped devise a formula using vegetable proteins that accustoms children to a high-protein diet. “We were so thankful that these doctors from so far away would volunteer their time to help us,” the dental student said.

The five-year civil war has plunged the Madaya clinicians into the deep end, forcing them to perform medical procedures that push them far beyond their training. They have treated countless gunshot victims, performed seven amputations, over a dozen C-sections, and diagnosed everything from meningitis to cancer, they told me during multiple conversations over WhatsApp and Facebook. “I’ve learned as I go,” the dental student said when we chatted over Facebook in August. “God willing, I am able to help as many people as possible.”

But there are limits to what they can do. Every day, one member of the group, a Virginia-based internist, obsessively checks the WhatsApp group for new messages: at 4 a.m. when she wakes up to breastfeed her newborn daughter, or on her lunch break at her clinic. In recent weeks, she has been trying to help the Madaya clinicians diagnose a woman who suddenly lost her vision, without warning, and is experiencing hallucinations. If a patient walked into her clinic with those symptoms, the internist said, she would immediately order an MRI. But since there’s no MRI machine in Madaya, she and three other doctors have been working to diagnose the woman “empirically,” trying out different medications the clinic happens to have and seeing if they work.

In July, as the internist recovered from the birth of her second child, she helped the Madaya clinicians perform a C-section on a woman pregnant with twins. The veterinarian, fortunately, was comfortable making the incision. But he was unprepared for all the blood the mother would lose after giving birth to two babies. So the internist explained that the woman needed a transfusion. She advised the dental student to transfer two units of blood every 30 minutes—the gap between transfusions was critical, she explained, to allow time to observe whether the mother was having an allergic reaction to the blood.

The whole exchange took place in a series of rapid-fire text messages. Though the Madaya clinicians sometimes send photos or videos of their procedures, the town’s patchy cell-phone-enabled internet service can’t reliably stream videos, and only sometimes supports phone calls. In the end, the C-section was a success; the newborns and mother are healthy and back at home. Still, no amount of hands on experience—even crash courses in surgery and complex diagnostics—can substitute for formal training. “Sometimes, talking to those two is like speaking with a first-year medical student,” the internist said. “You never know what they will know or what will be new to them.”

Doctor Silvia Dallatomasina, the medical-operations manager for Doctors Without Borders’s Syria office, explained that almost everywhere across the country “the medical staff is young or inexperienced, out of their comfort zone.” That dynamic is supercharged in Madaya. “There’s no second clinic to fall back on. You can’t bring in a doctor from a neighboring community,” explained Valerie Szybala, the executive director of the Syrian Institute, a nonprofit that helps run Siege Watch, a project monitoring Syria’s besieged communities. “For patients, there is nowhere to go. It’s that clinic, or nothing.”

At times, the group does indeed resemble a classroom. For hours every day in the chat group, doctors and the Madaya clinicians discuss the merits of different antibiotics, or analyze the urine of a patient, or try to devise a workaround for a surgery. The orthopedic surgeon in Michigan recently taught the dental student how to perform minor hand surgery without general anesthetic by suppressing a nerve in the hand to temporarily numb a wounded finger. “We became more professional, more precise,” the dental student said. “In some ways, its been an academic experience, learning things I had no way of knowing before.”

“We thank God for the group,” the veterinarian told me at the end of a full-day shift at the clinic, via a WhatsApp audio message. “Without them, we would have more questions than answers.”

For many of the doctors in the WhatsApp group, the digital thread tethering them to Madaya has become an obsession. The pulmonologist described constantly looking at his phone, even while driving in traffic, to make sure the group is answering all the questions that come up. “I can’t let it go,” he said. “My soul is attached there.” The orthopedic surgeon said he checks the chat room “multiple times every day.” Before the WhatsApp group, he had to switch off the television whenever it showed images of the Syrian civil war, overwhelmed by a feeling of helplessness. “I just shut my brain up. I didn’t want people even talking to me about it,” he said.

For the past five years, he has been in touch with his family in Aleppo, the northern province that’s become the center of the Syrian conflict in recent months. When his cousins talk about the horrors of life in a war zone, all he can say is “I’m sorry, I’m sorry,” leaving him feeling “like a jackass,” he said. Though he has no personal connection to Madaya, the WhatsApp group has given him a feeling of concrete solidarity with those suffering in Syria.

Born and raised in Damascus, the internist hasn’t been able to return to her native Syria or see her parents in five years. The WhatsApp group, she said, offers her a “portal” back into her homeland, a rare opportunity to alleviate suffering. She still has fond childhood memories of Madaya: She and her sister used to drive there from Damascus to buy rare fruits smuggled into Syria from across the Lebanese border.

Remote medicine, of course, is not enough to keep Madaya healthy. Many of the conversations in the WhatsApp group fizzle out as the doctors realize the clinic doesn’t have the right medicine or equipment—or that the Madaya clinicians can’t perform the needed procedures, like brain surgery or a lumpectomy. At that point, the doctors will promise to pray for the patient, and the chat room goes silent. When asked if these dead ends discourage him, the pulmonologist paraphrased a verse from the Koran: “If we save one life, it is as if we are saving the whole of humanity.”

http://www.theatlantic.com/international/archive/2016/08/syria-madaya-doctors-whatsapp-facebook-surgery-assad/496958/

by Paul Ratner

Italian neurosurgeon Sergio Canavero is planning to perform the first-ever head transplant in December 2017. He will put the head of a terminally ill, wheelchair-bound Russian citizen Valery Spiridonov (31) on an entirely new body.

Spiridonov, a computer scientist, has Werdnig-Hoffman disease, a rare and incurable spinal muscular atrophy. As the disease is sure to kill him, Spiridonov sees the head transplant as his one shot to have a new body.

The controversial surgeon Canavero, dubbed by some “Dr. Frankenstein,” has been criticized for intending to do a possibly unethical and certainly dangerous operation. There are numerous things that could go wrong in such a medical feat that’s never been successfully carried out on humans. The main difficulty is seen in the fusion of the spinal cords.

One positive precedent has been set earlier this year by a team of Chinese surgeons, who successfully transplanted a monkey’s head. Dr. Xiaoping Ren, from Harbin Medical University, led that effort.

Canavero is raising around $18 million to pay for the procedure that he named “HEAVEN” (an acronym for “head anastomosis venture”). The details the doctor has given so far for the two-day operation first involve cooling the patient’s head to -15 C. Then the heads of both the patient and the donor would be severed and the patient’s head would be attached to the donor’s body. The spinal cords would be fused together while the muscle and blood supply would be attached. Spiridonov would then be placed into a coma for about a month to prevent movement and to allow for healing.

The donor of the body would be brain-dead, but otherwise healthy.

How does Spiridonov feel about doing the revolutionary surgery?

He says in an interview:

“If I manage to replace my body and if everything goes well, it will allow me to be free of the limitations I am experiencing. I am not rushing to go under the surgeon’s knife, I am not shouting – come and save me here and now. Yes, I do have a disease which often leads to death, but my first role in this project is not that of a patient. First of all, I am a scientist, I am an engineer, and I am keen to persuade people – medical professionals – that such operation is necessary. I am not going crazy here and rushing to cut off my head, believe me. The surgery will take place only when all believe that the success is 99% possible. In other words, the main task now is to get support for Canavero from the medical community, to let him go on with his methods and to improve them within these two coming years.

Canavero sees the potential use of his procedure not only in situations involving patients with severe disabilities like Spiridonov’s, but also to extend life.

“We are one step closer to extend life indefinitely because when I will be able to give a new body to an 80-year-old they could live for other 40 years,” said the Italian surgeon.

http://bigthink.com/paul-ratner/worlds-first-human-head-transplant-going-ahead

A robot surgeon has been taught to perform a delicate procedure—stitching soft tissue together with a needle and thread—more precisely and reliably than even the best human doctor.

The Smart Tissue Autonomous Robot (STAR), developed by researchers at Children’s National Health System in Washington, D.C., uses an advanced 3-D imaging system and very precise force sensing to apply stitches with submillimeter precision. The system was designed to copy state-of-the art surgical practice, but in tests involving living pigs, it proved capable of outperforming its teachers.

Currently, most surgical robots are controlled remotely, and no automated surgical system has been used to manipulate soft tissue. So the work, described today in the journal Science Translational Medicine, shows the potential for automated surgical tools to improve patient outcomes. More than 45 million soft-tissue surgeries are performed in the U.S. each year. Examples include hernia operations and repairs of torn muscles.

“Imagine that you need a surgery, or your loved one needs a surgery,” says Peter Kim, a pediatric surgeon at Children’s National, who led the work. “Wouldn’t it be critical to have the best surgeon and the best surgical techniques available?”

Kim does not see the technology replacing human surgeons. He explains that a surgeon still oversees the robot’s work and will take over in an emergency, such as unexpected bleeding.

“Even though we take pride in our craft of doing surgical procedures, to have a machine or tool that works with us in ensuring better outcome safety and reducing complications—[there] would be a tremendous benefit,” Kim says. The new system is an impressive example of a robot performing delicate manipulation. If robots can master human-level dexterity, they could conceivably take on many more tasks and jobs.

STAR consists of an industrial robot equipped with several custom-made components. The researchers developed a force-sensitive device for suturing and, most important, a near-infrared camera capable of imaging soft tissue in detail when fluorescent markers are injected.

“It’s an important result,” says Ken Goldberg, a professor at UC Berkeley who is also developing robotic surgical systems. “The innovation in 3-D sensing is particularly interesting.”

Goldberg’s team is developed surgical robots that could be more flexible than STAR because instead of being manually programmed, they can learn automatically by observing expert surgeons. “Copying the skill of experts is really the next step here,” he says.

https://www.technologyreview.com/s/601378/nimble-fingered-robot-outperforms-the-best-human-surgeons/

Thanks to Kebmodee for bringing this to the It’s Interesting community.

The likely date and location for the first-ever human head transplant have been set, after the controversial Italian doctor that will lead the surgery said that he has selected his team of surgeons.

Radical Italian surgeon Sergio Canavero has drawn fascination and criticism after he announced plans to cut off a man’s head and put it onto another body. Many had expected that the planned operation would probably never happen – but a team has now been appointed to lead the operation.

Canavero is hoping to complete the procedure – which will take 36-hours, and cost $11 million – by December 2017, according to Russia Today.

The transplant is likely to happen in China, with a team made up largely of doctors from the country, according to AFP. That is likely to raise worries about the already highly-controversial operation, since China has been criticised for using the organs of executed prisoners without their consent.

The procedure has already drawn widespread condemnation, from doctors who say that it is likely to kill the person undergoing it, and that if he does survive he will undergo something a “lot worse than death”.

Russian Valery Spiridonov has already been selected as the recipient of the new body. He suffers from the rare, genetic Werdnig-Hoffmann disease, which gradually wastes away his muscles.

During the procedure, the donor and patient will each have their head sliced off their body in a super-fast procedure. The transplanted parts will then be stuck together with glue and stitches.

Spiridinov will then be placed in a month-long coma and injected with drugs intended to stop the body and head from rejecting each other.

Since the procedure is unprecedented, apart from mixed results in dogs and monkeys, doctors are not sure what could happen during the surgery – or how Spiridinov is likely to be if and when he wakes up.

Ren Xiaoping, who will work with Canavero to try and attempt the procedure in the next two years, said that the team will only attempt it if research and tests show that it is likely to be successful.

The operation will probably happen in China, at the Harbin Medical University, according to reports.

Since Ren refused to say where the donated body might be found, some have worried that the donated body might be taken from an executed prisoner.

In China – where the huge population and a low number of donations have led to a high demand for organs – an industry of forced donations and a black market for the sale of organs have flourished.

Canavero has said that China is keen to be involved in the procedure as a way of demonstrating its keenness for scientific research to the world, likening the race to complete the transplant to the space race. The Italian doctor has recognised that he could go to jail for performing the procedure in an unfriendly country and said that he has “been studying Chinese for a few years”.

The doctor has said that the procedure is just a first step towards his ultimate aim of immortality.

http://www.independent.co.uk/life-style/gadgets-and-tech/news/head-transplant-team-selected-for-controversial-operation-that-will-go-ahead-in-2017-10498627.html

Thanks to Kebmodee for bringing this to the It’s Interesting community.

A new treatment has successfully changed the color of people’s eyes in Latin America, but the procedure isn’t approved in the U.S. yet.

For years, a California-based company called Stroma Medical has been publicizing a laser procedure that turns brown eyes blue. Theoretically, this would give brown-eyed individuals the choice to change the tint of their irises, not unlike the way many decide to use surgery to alter the noses or chests they were born with.

Now Stroma Medical claims that it has conducted 37 successful treatments on patients in Mexico and Costa Rica. It also says that it would likely charge about $5,000 for anyone wanting the procedure. That is, of course, only if and when American medical safety regulators give the surgery the green light in the United States.

Company chairman Gregg Homer says the procedure works by disturbing the thin layer of pigment that exists on the surfaces of all brown irises.

“The fundamental principle is that under every brown eye is a blue eye,” Homer told CNN. “If you take that pigment away, then the light can enter the stroma—the little fibers that look like bicycle spokes in a light eye—and when the light scatters it only reflects back the shortest wavelengths and that’s the blue end of the spectrum.”

Although the treatment lasts only 20 seconds, the patient’s eye color isn’t changed right away. Instead, it takes a few weeks for the human body to remove the pigmented tissue, resulting in blue eyes.

Given that light eyes are increasingly rare, with less than a fifth of Americans boasting blue peepers, it’s easy to see how there might be demand for this procedure. A preference for blue eyes in Western societies has been documented in many unscientific ways, though controlled studies suggest that the blue-eyes-are-more-attractive stereotype is more a product of culture than unconscious preference.

Whether or not you feel this procedure is a net good—or bad—thing for society, a bigger concern might be safety.

Though Stroma claims the surgery is safe, at least one ophthalmologist cautioned that the shedding of pigment could clog up drainage channels in the eye, increasing pressure and the risk for glaucoma.

http://time.com/money/3733372/surgery-turn-brown-eyes-blue/