88 research outputs found
Medical history for anesthesiologists: Lesson 3. Medical history for anesthesiologists: continuation of a primer
No full textEditor's note: The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai lo provide a primer on the history of medicine and anesthesia
Primer on Medical History for Anesthesiologists: Introduction
No full textEditor’s note: The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai to provide a survey of medical history. The goals of this primer are 1) to educate, and 2) to help individuals target future study. Below is the first article in a continuing series
Medical History for Anesthesiologists: Continuation of a Primer
No full textEditor’s note: The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai to provide a primer on the history of medicine and anesthesia history. The goals of this primer are to educate and to help individuals target future study. Below is the second article in a continuing series
The discovery of modern anaesthesia-contributions of Davy, Clarke, Long, Wells and Morton
No full textWhile many may argue as to who deserves the most credit for the discovery of modern anaesthesia, events in the late 18 th and early 19 th centuries led to the introduction and development of modern anaesthetic techniques.
English physicist and chemist Humphry Davy [1778-1829] first became aware of the sedative and analgesic properties of nitrous oxide in 1795. Although he never experimented with the drug during a surgical procedure, he was the first to suggest that it would be beneficial in relieving pain during surgical procedures. The mind-altering properties of nitrous oxide and ether were often abused for recreational purposes, and the term ′ether frolics′ was coined to describe such use. While physician William Crawford Williamson Long [1815-1878] first used ether during general surgery, medical student William Edward Clarke [1819-1898] was the first to use ether for dental extraction in 1842. Dr. Long neglected to publicize his findings until 1849, thereby denying himself much of the credit he deserved. Dentist Horace Wells [1815-1848] successfully used nitrous oxide for dental procedures, but a public demonstration which he held in January 1845 turned out to be a fiasco. Medical student William Thomas Green Morton [1819-1868] was the first to publicly demonstrate the effectiveness of ether for general surgery on October 16, 1846. This article seeks to give rightful credit to each of these individuals for their unique contributions to the discovery of modern anaesthesia
Discovery of Modern Anesthesia: A Counterfactual Narrative about Crawford W. Long, Horace Wells, Charles T. Jackson, and William T. G. Morton
No full textThe discovery of anesthesia occurred during a narrow time span in the mid-19th century, but there is no agreement about who deserves credit for this important American contribution to medicine. Based mostly on an examination of primary sources, we explore how formal and informal interactions between the principals affected their careers, lives, and attribution of credit for the discovery of anesthesia. There should be no controversy as to which individual deserves credit for the discovery of anesthesia if credit is ascribed for specific contributions. We suggest that credit for the discovery of anesthesia be divided among 4 individuals who played specific roles. Crawford W. Long first used ether as an anesthetic during surgery, Horace Wells introduced nitrous oxide for pain relief during dental surgery, and William T. G. Morton gave the first public demonstration of ether anesthesia and spread the word about its efficacy. Charles T. Jackson suggested the use of ether as an anesthetic agent to Morton. We also assert that had these individuals not known one another, the discovery of anesthesia would have proceeded in approximately the same timeframe, but Wells, Morton, and Jackson would have enjoyed more productive careers as well as longer, more peaceful lives
Pharmacogenomic and mechanistic studies on dietary factors in chemoprevention of cancer
No full textPharmacogenomic profiling of cancer has recently seen much activity with the accessibility of the newest generation of high-throughput platforms and technologies. A myriad of mechanistic studies have been devoted to identifying dietary factors that can help prevent cancer, with evidence gleaned from epidemiologic studies revealing an inverse correlation between the intake of cruciferous vegetables and the risk of certain types of cancer. To develop a comprehensive understanding of cancer pathogenesis, and potential for chemopreventive intervention with dietary factors, an integrated approach that encompasses both pharmacogenomic and mechanistic aspects is desirable. Our transcriptomic profiling of butylated hydroxyanisole-induced Nuclear Factor-E2-related factor 2 (Nrf2)-dependent genes in Nrf2-deficient mice identified several germane molecular targets for prevention. Toxicogenomic analyses of endoplasmic reticulum stress inducer tunicamycin in Nrf2-deficient mice elucidated Nrf2-regulated unfolded protein response effects. Mechanistic studies on a combination of sulforaphane and (-) epigallocatechin-3-gallate in HT-29 AP-1 (Activator Protein-1) cells revealed a synergy in colon cancer chemoprevention. Pharmacogenomic studies of this combination in PC-3 AP-1 cells provided a discursive framework for understanding putative crosstalk between Nrf2 and AP-1 in prostate cancer chemoprevention. Regulatory potential for concerted modulation of Nrf2 and Nuclear Factor-κB (Nfκb1) in inflammation and carcinogenesis was delineated by bioinformatic analyses. Metabolomic approaches identified potential prognostic biomarkers in human prostate cancer. Differential biological networks in prostate cancer were elicited in androgen-dependent 22Rv1 cells, androgen- and estrogen-dependent LNCaP cells and androgen-independent DU 145 and PC-3 cells. Taken together, our identification of Nrf2-regulated molecular targets by expression profiling using dietary factors, synergistic effects in combinatorial use of dietary factors in colon cancer, regulatory studies on crosstalk between Nrf2 and AP-1 in prostate cancer, bioinformatic analyses of concerted modulation of Nrf2 and Nfkb1 in inflammation and carcinogenesis, metabolomic identification of biomarkers, and delineation of target hubs in differential prostate cancer biological networks, greatly enhance our understanding of the transcriptional circuitry in cancer and important master regulatory nodes including Nrf2 that might potentially be exploited for chemopreventive intervention with dietary factors.Ph.D.Includes bibliographical references (p. 311-331)
History of anaesthesia. Nurse anaesthesia practice in the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America)
No full textMany factors determine whether nurses, physicians or both administer anaesthesia in any country. We examined the status of nurse-administered anaesthesia in the Group of Seven (G7) countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America) and explored how historical factors, mixing global and local contexts (such as professional relations, medical and nursing education, social status of nurses, demographics and World Wars in the 20th century), help explain observed differences. Nearly equal numbers of physicians and nurses are currently engaged in the delivery of anaesthesia care in the United States but, remarkably, although the introduction or re-introduction of nurse anaesthesia in the 20th century was attempted in all the other G7 countries (except Japan), it has been successful only in France because of the cooperation with the United States during World War II
Disparity in endoscopic localisation of early distal colorectal cancers: a retrospective cohort analysis from a single institution
No full textBACKGROUND: Accurate staging of distal colorectal cancers is paramount in guiding neoadjuvant therapy, peri-operative, and ostomy planning. Early colonic lesions can be difficult to visualise on computed tomography (CT) scans, with tumour location solely deduced via endoscopy with the potential for introducing error. We aimed to address the paucity in literature in this area and assessed the accuracy of radiological and endoscopic localisation of distal colorectal cancers. METHODS: Retrospective analysis of an electronic database of patients at a large District General Hospital (DGH) diagnosed with distal colorectal cancer between January 2014 to January 2023 was performed. Patient demographics, investigations, endoscopic, and operative findings were analysed. Outcomes were assessed to determine disparities between pre-operative endoscopy and final tumour location. RESULTS: A total of 212 patients were endoscopically diagnosed with distal sigmoid tumour. Of these, 207 (97.6%) had a CT scan performed with 25.1% (52/207) lesions not being identified on this imaging modality with the remainder (74.9%; 155/207) being reported as visible. 38.2% (79/207) of tumours were in the sigmoid colon, 17.4% (36/207) rectosigmoid, and 19.3% (40/207) in the rectum. Pre-operative magnetic resonance imaging (MRI) was performed in 42.5% (90/212) of cases showing 84 tumours: 6.0% (5/84) sigmoid colon, 9.5% (8/84) rectosigmoid and 83.3% (70/84) rectal cancers (upper: 34, mid-rectum: 26, low: 10), with one anal cancer. 42.3% (22/52) of patients with non-visible lesions on CT had MRI scans: 68.2% (15/22) had rectal cancer (upper: 10, mid-rectum: 4, low: 1). Of the 30 where MRI was not performed, 46.7% (14) had sigmoid cancer, 16.7% (5) rectosigmoid, and 33.3% (10) rectal intraoperatively. Overall, 30.7% (65/212) of patients reported as having a distal sigmoid lesion endoscopically in fact had rectal cancer intra-operatively (rectosigmoid lesions excluded). CONCLUSION: Endoscopic localisation of distal colorectal tumours can be unreliable for accurate staging and operative planning. A pre-operative MRI scan should be considered in such instances, and particularly for non-visible lesions on CT scan. This may improve peri-operative planning, staging accuracy and patient outcomes.Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.Not hel
Whole-Body Nitrogen and Tyrosine Metabolism in Surgical Patients Receiving Branched-Chain Amino Acid Solutions
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