WIKI 1 After doing exercises A, B, D and E from page 16 and C (2.4) from page 18 (DO NOT give the solutions to these exercises here!), write down a paragraph on the following topic: A MEDICAL ACHIEVEMENT WHICH YOU THINK IS IMPORTANT FOR MEDICINE (you CANNOT repeat any of your colleagues')
Copying from the internet is not allowed!!
THE DISCOVERY OF THE X-RAYS
Wilhelm Conrad Roentgen made in 1895 an investigation with cathode-rays. While he was experimenting with electric current in the inside of the Crookes? tube, he discovered some unknown rays that were able to create an intense fluorescence and went through some materials that are very thick. This fluorescence was very intense, you could see it two meters away from the tube.
Roentgen thought that he had discovered something new: THE X-RAYS
In 1901 was Nobel Prize Winner.
He was able to take a photo of the bones of his wife's hand with this rays.
Now we know that X-rays have many applications in therapy and diagnosis.
MORPHINE
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid.
Morphine was discovered as the first active alkaloid extracted from the opium poppy plant in December 1804 in Paderborn, Germany, by Friedrich Serturner. The drug was first marketed to the general public by Sertürner in 1817 as an analgesic, and also as a treatment for opium and alcohol addiction.
It acts directly on the central nervous system to relieve pain. There are many legitimate uses of morphine that make it a very important drug in the field of pain management. In the hospital setting, morphine is often used for pre and post operative pain management as well as in conjunction with the anesthesia used during surgical procedures. It is also used for pain management if a patient presents with traumatic injuries, such as those obtained during a car accident.
Sometimes morphine is prescribed by a doctor for use outside of a hospital. Patients who suffer from severe and chronic pains such as those associated with cancer, kidney stones or back pains may be take morphine to deal with the excruciating pain associated with their conditions.
The principal disadvantages are the tolerance and physical and psychological dependence develop quickly. Morphine was the most commonly abused narcotic analgesic in the world until heroin was synthesized and came into use. Withdrawal from morphine causes nausea, tearing, yawning, chills, and sweating lasting up to three days. Morphine crosses the placental barrier, and babies born to morphine-using mothers go through withdrawal
I think that morphine is a useful drug but people should use it only under medical prescription.
EPIDURAL ANESTHETIC
Perhaps one of the most important achievements for modern medicine is the development of the epidural anaesthetic. It consists of an injection into the epidural space (located on or over the dura madre) of the spine, as of an anaesthetic to control pain during childbirth. I think that this achievement is so important because it makes things easier for women. How many of them, at the moment of their childbirth, had to use general anaesthesia being not able to see their own labor or had to support pain to be able to see their childbirth? Nowadays this question is forgotten for most women, because they are both finally possible: see your childbirth without feeling pain. That must be great for each and every mother.
It’s usually placed when the cervix is dilated to four or five centimetres and woman is on true active labor.
Nevertheless is not as advantageous as it seems, epidural anaesthesia requires a high level of technical proficiency to avoid serious complications and is always given by an anaesthetist.
Although it’s very comfortable for mothers, some side effects could appear like a drop in blood pressure that’s why blood pressure must be controlated at frequent intervals during the labor. Another undesirable effect is headache which requires strong analgesia; the risk seems to be higher with younger age and larger size of needle. Finally the risk of paralysis is extremely low.
To sum up, epidural is a great achievement for women because, in spite of a few disadvantages, it helps to have a more positive labor experience, allowing mothers to be active participants.
HOSPITALS
A hospital is an institution provided with specialized staff and equipment dedicated to the treatment of sick persons. Considering this definition, I think that one of the greatest achievements in medicine has been the apparition of hospitals. It seems a very basic idea, and we might think that hospitals have always existed, but that’s not quite true. Actually, the first real hospital was the “Hotel de Dieu” in Paris, and that didn’t occur until year 651 d.C. It is true that before that year there were some institutions, usually associated to monasteries, which were dedicated to the treatment of sick persons, but they didn’t really fit in the definition we give nowadays to the word hospital.
And why do I think that this has been a very important achievement? On one hand, hospitals have been a shelter for the weak, where they could rest and have some time to recover; and on the other hand, they have given the opportunity to specialized persons to observe illness from the proximity, and develop ways of curing through experience and empiricism.
Concluding, the apparition of hospitals demonstrates the interest of human being for the wellness of his own kind.
INFLUENZA VIRUS
The biggest events about etiology, prevention and treatment during the last XX century took place in the world of tropical diseases. The virus identification and the introduction of chemotherapy were essential for eradicate the Influenza pandemic, described in Europe since 1510 and responsible of more than 25 millions of deaths after the First World War. In 1933 the English Doctors Wilson Smith (1897-1965), Patrick Playfair Laidlaw (1881-1940) and Christopher Howard Andrewes (1896-1989) demonstrated the virical origin of the Influenza Pandemia and cultivated it succesfully in laboratory conditions. Then it was possible to identify some immunological differences between the lineages A,B and C. In 1942 Thomas Francis (1900-1969) and Jonas Edward Salk (1914-1995) prepared the first vaccine against Influenza virus with poor results. In my opinion it is important to know that the Influenza Pandemic killed more people than the First World War so, the consequences of the war are always prolonged in the history. Sometimes in horrible conditions there is an opportunity for science to progress and help people.
ANTIBIOTICS
In my opinion, one of the greatest achievements in the whole history of medicine is the discovery and development of antibiotics, which began in the late nineteenth century. In common speech, the term “antibiotic” describes any substance that kills bacteria or inhibits their growth, but in the strict sense, this term refers only to those substances that are produced by microorganisms like fungi or bacteria. Nevertheless, in spite of the fact that some of these substances are still produced and isolated from living organism, most of them are now semisynthetic or even synthetic. It may be said that Paul Ehrlich was the pioneer in the story of antibiotic development. He discovered Salvarsan, an antimicrobial agent which was, however, quite toxic. Nowadays, thanks to the contribution of Fleming, Domagk, Florey, Chain and many others, there are a lot of these drugs available in the market, and they hardly cause adverse effects in comparison with the first ones. This development of antibiotics has permitted to control infections, which have caused so many deaths throughout the history. It´s certain that many people are still dying because of infectious diseases, because either they haven´t available drugs or they have a severe illness. However, many infections which probably would cause the death in the past are now cured without problems thanks to antibiotics.
IN VITRO REPRODUCTION
In honour of Robert Edwards, who recently received the Novel Price of Medicine and Physiology, I would like to talk about in vitro fertilization. He worked hard for this aim and his achievement made possible the first “test-tube baby” birth. Before this discovery, the privilege of “giving life” was reserved to God. But, fertilizing a human ovule became a fact in a laboratory. A step forward in this field made happy a lot of families that couldn’t have children, and it still happens nowadays. Nevertheless, these works arised polemic, they had a positive effect in society. He was very criticized by conservative and religious groups. He was even accused of pretending to be God. This ethical controversy damaged the development and the financing of the project. But thanks to private donations and without incentives for investment from the state, he continued to work. Despite these problems, assisted reproduction made possible four million of children to be born. A science miracle.
ORGAN TRANSPLANTS
An organ transplant is a surgical operation in which a failing or damaged organ in the human body is removed and replaced by a functioning one. The first reasonable account for this achievement was skin transplantation in nose reconstruction by the Indian surgeon Sushruta in the second century B.C. with which came the problem of tissue rejection. Centuries later, as evidence of great progress, regenerative medicine promises to solve this problem by regrowing organs in the lab, using the patients' own cells! However, lots of other problems are unsolved: as the rising success rate of transplants and modern immunosuppression make transplants more common, the need for more organs has become critical. And this is one of the problems that should be discussed in a bioethical perspective. Modern surgery is giving thousands of people a new lease on life through the selfless altruism of others. Nevertheless, we are facing dilemmas such as: What are the sources of organs used in transplantation? Should alcoholics be given liver transplants? How do we decide who will receive the implants? Regardless, in my opinion, the transplantation of organs is one of the greatest miracles of Medicine because it has changed the end of thousands of life stories. “It’s a gift of a lifetime”. See for yourself: http://www.organtransplants.org/
NON INVASIVE DIAGNOSIS TECHNIQUES
Possibly some of the greatest achievements in medical science have been “non invasive diagnosis techniques”, we are talking about those which are used in radiology. In 1895, the physics Wilhem Conrad Röentgen using the Crooke's tubes and a complex coil mechanism, managed to create X-rays. The rays strikes on photographic paper, making up the final picture (like a photo). The first picture using X-rays was his wife's hand. Nowadays, this apparently easy concept has become the pillar of powerful diagnostic techniques like Computered axial tomography (CAT or CT scan) or magnetic resonance imaging (MRI), which are essential in hospitals. The CT scan was introduced in the 1970s, but at the moment it is a very important tool in medical imaging, even its importance grows every day. We get a sectional image on different planes but the most used is transverse plane.
It has many applications but on the other hand the risk of using CT scan is the radiation exposure (1 CT thorax scan is equivalent to 400 thoraxes X-ray). That’s the reason why the CT’s use must be very reasonable.
Unlike CT, MRI uses no ionizing radiation. It uses the amount of hydrogen atoms of a tissue to draw the structure. The matter is that it costs much more.
Finally, I would like to say that radiology’s techniques are still rising and developing, this make easier diagnosis, screening or even treatment of diseases, but we can’t use it without responsibility.
PENICILIN
Penicillin was discovered in 1928 by Alexander Fleming, who won the Nobel Prize in 1945. It was the first antibiotic substance on history, and it supposed a huge step in medicine´s development, because with antibiotics, several diseases that had an elevated mortality rate could be healed giving a new hope. The discovering was the result of a forgetfulness happened to Fleming when he was working at his laboratory. He forgot a colony of Staphylococci exposed to the air and it was contaminated by a fungus that destroyed a part of the colony with an antibiotic substance. An antibiotic is a chemical substance synthesized by an alive organism, and it has the function to destroy contaminants microorganisms such as bacterias or viruses, so these drugs were destinated to fight infectious diseases, increasing human´s survival and extending life. Since penicillin discovery, antibiotics had suffered a lot of pharmacological changes, and nowadays we have a big spectrum of drugs to combat microorganisms. The scientists Howard Florey and Ernst Chain also contributed to the development of penicillin, because they were the responsibles of commercialize it, helping people to get the drug when they needed it. Both of them shared the Nobel Prize with Fleming.
DNA
DNA is a molecule that can be found on the nucleus of every cell in a person’s body and has the instructions on how to construct and operate it. This molecule is ‘divided’ in genes, each of them has a piece of these instructions. Discovery of DNA is quite new, its study began in 1868 with Friedrich Miescher, a Swiss biologist who carried out the first carefully thought out chemical studies on the nuclei of cells but was in the next century, in 1943 that the first direct evidence of DNA as the bearer of genetic information emerged. This is an important achievement because the identification of genes in the DNA allowed for the improved ability to diagnose a disease, detect genetic predisposition to a disease, create new drugs and new therapies as treatment. All of this gives a chance to patients who had once untreatable illnesses. In the research area, the study of DNA and genes shed light on the cause and mechanisms of development of some diseases that prior to its discovery we had little information.
VACCINATIONS
Measles and Poliomyelitis are two diseases that killed millions of people in the past. Nowadays, diseases like those rarely cause victims, just because someone invented the vaccination. The word vaccination was first used by Edward Jenner, in 1796, when he saw that people who came in contact with the bovine virus, had a less severe disease. So, Edward started to apply the cowpox liquid on the skin lesions. Nowadays, vaccines are produced with attenuated or dead virus or bacteria and are inoculated into the human body, thus stimulating the immune system to produce antibodies against this antigen. Once vaccinated, if the person gets in contact with this virus or bacteria, his immune system is able to recognize them and remove them promptly. But, if vaccines offer more defences to the human body against some diseases, why do some parents refuse to give vaccines to their children? I think this can be related with two factors: a cultural factor and a fear of the vaccination risks. A cultural factor related with religious issues. Some religions don’t allow that ‘animal stuff’ should be introduced on the human body of their children (some vaccines are produced using animal serum). The fear of vaccination risks is very common, because despite vaccines having a wide safety margin, there is a low probability of complications. Anyway I think everyone should vaccinate not only because it’s better safe than sorry, but also because it helps to protect the entire community by reducing the spread of infectious agents.
ASEPSIS
In my opinion, asepsis has been a very important discovery in History. In the past, many people died because of infections; not infections produced by very pathogenic microorganisms, but just common germs that could have been easily eliminated with basis hygienic measures. One of the pioneers in this area was the Hungarian Ignác Semmelweis. He lived in 19th century, and he was the first doctor who said that many women who died after giving birth to their babies could be saved if the doctors who treated them washed their hands before. In spite of some publications that proved that the incidence of puerperal fever (the main cause of the high mortality among those women) decreased if doctors washed their hands before treating their patients, the medical community didn’t believe him. Until a few years later of Semmelweis’s death (he wounded himself with a scalpel previously used to cut a corpse, in order to prove he was right), when Pasteur published his research about microorganisms, the theory of Semmelweis wasn’t reconsidered. I think asepsis is important because it’s very related to the discovery of antibiotics, as it’s necessary to know first that pathogenic microorganisms exist if we want to fight them. Indeed, asepsis is a broad concept which is useful in almost any area of medicine: from healing of little wounds to prevent nosocomial infections in an invasive cardiothoracic surgery.
MICROSCOPE
For me, the invention of the microscope is probably the main argument to explain why life expectancy has grown up so incredibly in the last centuries. In the past, most of deaths and plagues were due to infections, but nobody knew that there were microorganisms who could attack us. Actually, even the existence of microorganisms was not known. Obviously, it was not possible to know it until Galileo Galilei (for the Italians) or Zacharias Janssen (for the Dutchmen) created the microscope in 1610. Not only the development of microbiology was then possible. Robert Hooke in 1665 made the first observation of cells, which were described later as the basic structure of living organisms: it was the birth of cellular biology and histology. Later, Anton van Leeuwenhoek described for the first time bacteria, spermatozoids, red cells and protozoos. He is considered as the founder of Bacteriology. Thanks to those inventions and observations were possible the development of antibiotics, vaccinations and a lot of another discoveries which have made our lives easier, and have controlled so many diseases, or even eradicated them. Without the microscope, none of this would have happened, because nobody would have ever discovered that microorganisms existed and were the main cause of millions of deaths and illnesses.
CHEMOTHERAPY
I think that the use of chemotherapy (any medical treatment based on the administration of chemist substance) is one of the most important achievement on the medicine history cause it has a really important and extensive use. The first chemotherapy treatment was invented by Paul Ehrlich in 1907 for the tripanosomiasis infection. Nowadays, chemotherapy is used for the treatment of tuberculosis, some autoimmune disease and cancer (one of the most extended disease of our times). The use of chemotherapy at cancer began in 1940 with the study of a chemist weapon used in the World War II, the mustard gas. Louis S.Goodman and Alfred Gidman were recruited by the Defense Department of the USA. They observed that people who died by mustard gas had a decrease of the lymph. So, they thought that this substance could be used to cure lymphomas. After a lot of experiments, they could demonstrate it. That was the first step of the demonstration that cancer can be treated by chemotherapy.
INSULIN
The discovery of insulin deserved the Nobel Prize in 1923, and it was a great advance in medicine. It's used for the treatment of diabetes, a chronic illness that affects 250 millions of people in the wide world, with 4 millions of deaths every year. The insulin is an anabolic hormone that allows the glucose capture( between other actions), and its failure produces high levels of glucose, hyperglycemia, that affects the whole body, specially eyes, kidneys, vessels and nervous terminations, with many complications that causes many deaths. Nowadays human insulin used in treatment is biosynthetic, thanks to engineering techniques using recombinant DNA technology that makes possible an insulin with less impurities, a very useful form that avoids allergies. The advantage of insulin is the different ways of administration: subcutaneous, insulin pump, inhalation, transdermal, oral insulin and also the fast action of the insulin after administration, that allows higher quality of daily life, because the patient can eat at not scheduled hour. But aren't all advantages, the great inconvenient is the risk of hypoglycemia and the other important inconvenient is that allows the treatment of DM type 1, where there is no pancreas production of insulin, but in DM type 2 there is a resistance at the action of insulin, so this treatment is not effective. But the advantages are more important than the disadvantages, and because of all the people that are treated with insulin and have a better life and as healthy as possible.
CORONARY CATHETERIZATION
"You certainly can't begin surgery in that manner"
In 1929, German cardiology intern Werner Forssmann was demoted from his cardiology internship to the urology one, because he allegedly didn't know how to start a surgery properly. In fact, he had settled the basements of a medical technique which has since probed useful in the study of haemodynamics, and the diagnosis and treatment of several heart conditions. He was awarded the Nobel Prize for Medicine and Physiology in 1956 for that discovery. What, however, was this either success or outrageous fact? Pushing an urology catheter up the veins
Earlier that year, Forssmann asked a nurse in the Eberswald hospital for help: he needed access to some surgical instrumental, which she could provide. Then he sat on an operating table and anesthetized his forearm, and performed a phlebotomy in his brachial vein. As a next step, he pushed a urology catheter up his vein and 65cm far until he considered he had reached the right atria. Now, he stepped down the table and walked to the Radiology service, and shot himself a radiograph, to see just what he had thought: he had reached the cardiac chambers without performing any major surgery, but only a centimeters-small incision in his elbow. He showed his discovery at a congress, and his technique was seen as a valuable mean for measuring heart pressures, and also to deliver medicines directly to the heart. What happened to Forssmann later? He joined the Nazi Army and was imprisoned in WWII by the Allies. After his release in 1945 he continued practicing medicine in Germany, becoming Professor at Düsseldorf and eventually winning the Nobel Prize in 1956. Applications By means of Forssmann technique (improved by Swedish radiologist Seldinger), cardiologists can perform certain diagnostics and even treatments, some of which are: Haemodynamics Doctors can measure the different pressures of the heart chambers, which is vital in the diagnosis of conditions such are valve diseases. It also allowed physiologists to understand the functioning of valves and the changes that occur in the cardiac cycle. Coronary catheterization Coronary catheterization has a diagnosis and a therapeutic side. One can see the status of the lumen of coronary arteries, detecting any possible narrowing or occlusion that affects the adequate blood supply of the heart. The therapeutic use is, maybe, the most dramatic use of Forssmann’s technique. Now can doctors treat severe and critical diseases as are myocardial infarction or other forms of sudden cardiac arrest / acute coronary syndrome (ACS), as well as stable angina (chronic chest pain). As of 2008 more than one of these so-called angioplasties per mile inhabitants and year were performed in Spain. Some trials show that more than 90% of ACS patients intervened with angioplasty survive the episode of hospitalization. This technique can be performed also in other arteries, such as the arteries in the brain, kidney, and neck (cerebral, renal and carotid angioplasties).
ANAESTHESIOLOGY
One of the greatest achievement of medicine was undoubtedly anaesthesiology, due that since the beginning of the medicine has been looking for ways to eliminate pain. The first methods used was narcotics as mandrake, the during Middle Age was used henbane like local anaesthesiology. But it wasn’t until 1842 when Dr. Crawford Williamson Long used anaesthesia in a surgical intervention like a method of pain inhibition. He used ethyl ether. However, the discovery of anaesthesia is attributed to Dr. Morton in 1844. He built a gadget that allowed the administration of ether. After that, chloroform was quite used because of its greater efficiency in the sedation of pregnant women during childbirth. Since then, many anaesthetics have been discovered and, over the years, more and more powerful. Nowadays, anaesthetics have others utilities besides surgery like inhibit pain in endoscopy, interventional radiology, treatment of patients with cancer, etc. In conclusion, anesthesia is a medical procedure in which is used drugs to block touch or pain of a patient, either in whole or part of its body and be with or without impairment of consciousness.
ANTIRETROVIRAL DRUGS
Antiretroviral drugs were developed to be used for the treatment of infection by retroviruses, as everybody knows the most famous retrovirus is HIV, which causes a disease called AIDS. This disease is responsible for millions of death all over the world, mainly in developing counties. However, AIDS is no longer synonymous with death. Thanks to recent advances in antiretroviral drugs, in developed countries, HIV infection is almost completely controlled. For this reason, many researchers are going for that line of research. Suddenly, the HIV infection ceases to be a disease with very poor prognosis to be simply a chronic disease, and all this is the work of research of the disease and the improvement in antiretroviral drugs.
WINDOWS AT HOSPITAL
Everybody talks about a lot of discoveries, chemical substances or new techniques in medicine, but none of them have noticed some basics as windows at hospitals!!. Some years ago, as my mates have explained before, it was discovered lots of small cells that cause very dangerous diseases called microorganisms. Medical practice taught them (doctors), these little cells could be transported by thousands forms from people to people. For example, they realized that TBC (Tuberculosis) could be infected through the air. That was the reason why doctors decided to install these patients at special hospitals hoping not to infect more people. BUT they thought keeping windows shut would reduce the transmition to healthy people, and they did not pay attention to the fact that if they were always together, breathing the same contaminated air, they would not be able to cure anything!!Nurses opened windows as less as possible, because it was assumed that diseases would go out of the hospital and infect other people. But one day, by chance, they noticed that patients installed in a room with a broken window cured much faster than other patients. They studied these cases and saw that all their infections were reduced mainly because windows were sometimes open.
STEM CELLS
Stem cells have the potential to develop into many different cell types in the body; and in some kinds of tissues they participate in internal repair systems. They have got some particular characteristics that differentiate them from other types of cells: - They are unspecialized cells which can proliferate and renew themselves, so they can keep the group of cells that make up a tissue. - They can give rise to specialized cells. - They can regenerate a tissue or even an organ under certain physiologic or experimental conditions. There are different kinds of stem cells depending on their origin: embryonic cells which come from blastocyst; fetal cells originated in fetal blood, liver or lung; and somatic or adult stem cells that form part of several tissues (bone marrow, brain, skin, skeletal muscle, teeth, liver...). According to their potential to generate specialized cells, the embryonic ones have got more capacities than adult stem cells. From my point of view, they are one of the greatests medical achievements due to the possibility of tissue regeneration. Stem cells are an opportunity for thousands of illnesses whose medical or surgical treatments are not effective, as well as a new tool in organ transplants. At this moment they are being used in treatments of several pathologies: bone marrow transplant (the first one was made in 1968), autologous skin grafts, corneal reconstructions, diabetes… The research to find out their new opportunities or applications and to improve their use in humans continues unabated.
THE STETHOSCOPE
One of the most important achievements in the practice of Medicine was the invention of the stethoscope. The stethoscope was invented in France in 1819 by René Théophile Hyacinthe Laënnec. In the 19th century the only way of listening the cardiac sounds was to bring the ear close to the patient's chest. One day, Laënec was exploring a patient whose husband and mother were in the same room. He realized that her patient was too embarrassed, so he decided not to place directly his ear on his patient's chest in order to make her feel comfortable. So he took a notebook, rolled it, and put it on his patient's chest. He approached his ear and listened the heart beating as he never did before. That day he ordered to a carpenter to make a wooden cylinder of 30 cm long that would turn into the first stethoscope. Nowadays the stethoscope is composed of two rubber tubes that finish in two structures that you put in your ears. This two rubber tubes are also connected by the piece that you place on the chest. The stethoscope is one of the most useful diagnostic tools for the physicians. It allows them to explore both the cardiovascular system and the respiratory system, making possible the diagnosis by auscultation. Nowadays it is impossible to imagine the exploration without the use of the stethoscope.
PLASTIC SURGERY
Plastic surgery is a medical branch whose purpose is the rebuilt or restoration of different structures of the body that have been damaged. It includes several disciplines such as reconstructive surgery and cosmetic surgery. They both have many applications we will pay attention to below. The origin of plastic surgery is supposed to be hundreds of years before Christ (500 b.c.). It was in India where the first documents about plastic surgery were found. They belonged to the book Sushruta Shamita, written by Sushruta. Sushruta was the father of nose surgery (which is called “Rhinoplasty”). He used flaps to repair the destruction of nose. In India, nose was considered a very important organ. It was a sign of respect and importance. That is why it was very common to rip it off to the criminals as a way of punishment. Plastic surgery progression was strongly linked to the development of general surgery, anesthesia and antibiotics. They are so close, that plastic surgery would have never been possible without them. This is because it needs the processes of general surgery, and it is vital to prevent patients from pain and infections. One of the most famous procedures in plastic surgery is the “skin grafting”. In consists in take a little piece of skin from the patient body or other person, and put it in the place of the damaged zone, so that the defect can be hidden. There are too many techniques such as laser or microsurgery that can be also very useful in surgery treatment. Coming back to the different disciplines of plastic surgery, we have to make reference to cosmetic surgery and reconstructive surgery. The so called cosmetic surgery is totally up to date. It is not strange to see all the Hollywood stars with their perfect lips, breasts or noses and with hardly wrinkles in their faces. Nowadays, if you have money, you can perfectly use these treatments to get an extraordinary aspect, but I think plastic surgery is a great technique and it should be used to cure real disorders. Reconstructive surgery is one of the most important achievements medicine has ever managed, and that´s why I´ve chosen it as my topic. It is created to correct different disorders caused by traumatisms, burns, facial bone fractures, congenital abnormalities, tumors, etc. Some of the more common procedures are breast reconstruction after a mastectomy, hand surgery, scar treatment, and an endless list of techniques. It is very important because let people recover the function or appearance they used to have before an accident or another traumatic event. We mustn´t forget the psychic implications that every alteration of the body have, and that can be avoided with reconstructive surgery.
Non-steroidal anti-inflammatory drug (NSAIDs)
In my opinion, NSAIDs are an important achievement in medicine, because they are able to help in the treatment of multiple diseases.
NSAIDs are chemical substances with analgesic, antipyretic and anti-inflammatory effects. For this reason, they reduce inflammatory symptoms, and relieve the pain and the fever respectively. In this group of anti-inflamatory drugs are included popular medicaments as ibuprofeno, aspirine or paracetamol.
Mechanism of action: All drugs of this group work on the enzyme cyclooxygenase (COX), decreasing the production of prostaglandins, which participate in inflammatory process. John Vane, who later received a Nobel Prize for his work, elucidated this mechanism of action. Many aspects of the mechanism of action of NSAIDs remain unexplained, for this reason, further COX pathways were hypothesized.
NSAIDs are usually indicated for the treatment of acute or chronic conditions where pain and inflammation are present. For example: rheumatic diseases, gout, dysmenorrhoea, headache, fever, postoperative pain, renal colic…
Some of the advantages of this group of anti-inflammatory drugs are:
Do not produce respiratory depression.
Do not cause psychic or physical dependence.
Do not envelop tolerance.
On the other hand, we have to say that NSAIDs also could produce some adverse effects in specific situation. In general, they e very insurances, but they can cause for example digestive haemorrhages, peptic sores, photosensibility, or premature birth in pregnancy women.
Studying this information, we realize that NSAID provides us a useful tool to improve vital condition of patients without negative important repercussions.
HUMAN GENETICS THERAPY
I am going to deal with this topic because it is an excellent tool in healthy field all over the world, although it is not completely developed.
It is fundamentally considered as a deliberate administration of genetics material in a human patient with the purpose of delating a specific genetics defect or giving to the cells a new function. This administrated genetics material is normally a working gene.
Actually, it goes back to 1,990, when W. French Anderson proposed the use of marrow cells that had been treated with a retroviral vector within a correct copy of 'adenosin desaminasa' enzyme gene. It was applied to the treatment of SCID (a disease where this enzyme is mutated).
Bassically, this therapy needs the knowledge about how different mechanisms control the correct function in genes. Fortunately, it gave to us some good expectations in the attemp of preventing and treating different diseases, whose cause is located in DNA.
On the one hand, it is definitely an extremely good advance for health all over the world because like the italian doctor Pablo Argibay pointed out, this therapy will be usefull to improve interventionist medicine in the near future. Nevertheless, it will be really usefull when we will be able to know the expression, regulation and duration of the action of these therapeutic genes.
On the other hand, genetics therapy has numerous problems to evolutionate in an easy way. Firstly, science field would need to discover, understand and explain many other unresolved questions.
To sum up, I would like to remark that this tecnique has not been developed at all, but what is a really amazing advance is that we know how we will be able to make a good improve in science. Now, we don't only need to develop other fields, but also necessary money will have to be raised, which will not be an easy task to do.
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BLOOD TRANSFUSION
Blood transfusion is commonly defined as the process of transferring blood (or blood-based products) from one individual (donor) to another (recipient).
This process is one of the most important achievements in the history of medicine because it can save life in some situations (characterised by massive blood loss) or used to replace blood lost during surgery. Nowadays, it is widely admitted that if it were not for this discovery, human being would not have been able to make organ transplants.
It is believed that the first blood transfusion was made, a long time ago, by Australian aborigines. Sometime later, in 1665, the English physician Richard Lower kept a dog alive by transfusing blood from other dogs and in 1667, Jean-Baptiste Denis in France carried out the first successful blood transfusion from sheep to humans: he transfused the blood of a sheep into a 15-year old boy who, incredibly, survived the transfusion.
In 1818, the British obstetrician James Blundell performed the first successful transfusion of human blood to a patient for the treatment of postpartum haemorrhage and in 1840, Samuel Armstrong Lane, aided by James Blundell, carried out the first successful whole blood transfusion to treat haemophilia.
Almost a hundred years after, Karl Landsteiner, an Austrian physician, discovered the first three human blood groups (A, B and 0) and in 1906 Reuben Ottenberg developed the first blood transfusion using blood typing and cross-matching. These new achievements made safer the blood transfusion because the coagulation problems could be avoided.
Nowadays, blood transfusion is an essential element of modern health care. However, it may be used correctly, in order to minimize the risk of transmission of infectious agents, such as HIV, hepatitis B and C viruses, syphilis or Chagas disease.
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The first implant of a pacemaker (1958)
I think that one of the most important achievements for Medicine has been the PACEMAKER.
In the century XVIII, after the discovery of the electricity, the electrical implication was studied in the muscular contraction.
In 1855, the Frenchman Guillaume Duchenne de Bologne managed to stop a tachyarrhythmia of a 21-year-old patient who was affected of diphtheria, with the “electrical hand”.
The definitive development of the pacemaker was achieved by Hugo von Ziemsen, a German who demonstrated in 1882, that in an alive person, the ventricular activity is controlled by electrical impulses.
Albert Hyman tried it with an artificial pacemaker.
The experiences of Paul M.Zoll and Ake Senning, were the total success of the electrotherapy for diseases of the cardiac rhythm: Zoll implanted the external one, and Senning the internal one two years later.
The lucky patient was 40 years old, and thanks to the operation, it corrected a blockade atrioventricular.
And finally, we can say that thanks to the pacemaker which activates with electrodes the cardiac muscle, a lot of people with cardiac diseases, indeed get to have a better quality-life.
IN VITRO FERTILIZATION
I think that one of the most important achievements in medicine could be the development of "in vitro fertilization". Such is its importance that the discoverer, Robert G. Edwards, has been recently chosen for the Nobel Prize in Physiology or Medicine this year. Nearly 4 million babies were born as a result of the technique when families found problems in conceiving a child. Nowadays, lots of couples benefit from this achievement and are able to bring new life to this world. However, it is worth to mention that this achievement is not totally perfect. There are several controversial believes and thoughts that involve it... all the cells created to bring life are not always used to continue the process and are eliminated. That's why many people rise against this practice. Is it moral or not? That's the question to answer...
THE THECHNOLOGY IN MEDICINE
One of the most important achievement in the field of medicine is the improvement of the technology that allows the reseachers to be able to get the cure of many diseases. Besides, this improvement has been also used to the diagnose and operations (robots, laser surgery...) by the doctors.
Some examples of the technology used in medicine are:
- X RAYS: the x rays were discovered by Wilhelm Conrad Roentgen. They are a useful technique that allows us to detect especially bones diseases, besides others. The X Rays are so important that currently an specialization is devoted to the study of its images: the radiology.
-DEFIBRILLATOR: is one of the most used and the most important objects of the cardio pulmonary resucitation (CPR). There are several types, one of them is the automatic external defibrillator. This one allows diagnoses and treats a patient with a heart failure due to the heart has an electric activity but not mechanical. If the machine detects this failure then it will administer an electric impulse to the heart, this impulse makes the heart recover the normal heart rhythm.
-PACEMAKER: it is a small machine that implants in the patients whose heart has not an adequate rhythm. This machine generates electric impulses when detects an inadequate rhythm and frequency. The pacemaker when generates these impulses makes the patient has a normal hearbeat.
-PROTHESIS: they can be external (like arm prothesis) or internal (like hip prothesis). It consists on implanting an artificial limb due to the original one has been mutilated, amputated, broken or even deteriorated. What is looked for with the prothesis is recover the functionality of the original limb. In some cases this objetive is achieved,like the leg prothesis, but on the other hand there is another ones that because of complex functions that carries out is more difficult to create these prothesis.
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X- RAY DISCOVERY
This tecnique was discovered by Wilhelm Roentgen, and it suppossed a step forward in the history of medicine. This techonlogy gives the doctor the posibility to make visible the internal structures of the body without the necessity of surgery
X-ray is a very useful diagnostic tool, is used for taking images of internal structures.
In case of radiography, that works with this X-Rays, is oftenly used for the diagnostic of skeletal pathologies, but also is used in the diagnostic of other pathologies such as kidney stones or lung problems.
Other kind of test that works with this X-Rays technology is Computed Axial Tomography (CAT) wich is better for taking images of soft tissue.
This tecnique has a very important problem, because some studies have considered X-rays as carcinogen, and that is the reason because the persons who practise the test need protection.
Nowadays, this tests are very often used in the diagnosis of common diseases and that is why, in my opinion, the discovery of X-Ray by Roentgen is an important achievement in Medicine.
ETHICAL COMMITMENTS
There have been a lot of medical achievements and discoveries, but from the beginnings of medicine the human being's inherent questions have not been answered and nowadays these questions are present in general medical practice.
Thanks to the ethical commitments, the questions involving the morality can be answered by a group of experts in those topics. Things such as to make a medical abort, euthanasia, and how to deal with patients in certain circumstances are very polemic. Since the existence of ethical commitments, doctors involved in those moral discussions are supported by the opinion of the experts.
The ethical commitments are not only useful in the usual practice of the doctors. All the investigations of these years are also supported by them. A lot of discoveries until the middle of last century, in spite of the benefits of the achievements, have been non-moral and it worked against some people. Currently the investigations, supported by these commitments, do not threaten people's moral integrity.
After doing exercises A, B, D and E from page 16 and C (2.4) from page 18 (DO NOT give the solutions to these exercises here!), write down a paragraph on the following topic:
A MEDICAL ACHIEVEMENT WHICH YOU THINK IS IMPORTANT FOR MEDICINE (you CANNOT repeat any of your colleagues')
Copying from the internet is not allowed!!
THE DISCOVERY OF THE X-RAYS
Wilhelm Conrad Roentgen made in 1895 an investigation with cathode-rays. While he was experimenting with electric current in the inside of the Crookes? tube, he discovered some unknown rays that were able to create an intense fluorescence and went through some materials that are very thick. This fluorescence was very intense, you could see it two meters away from the tube.
Roentgen thought that he had discovered something new: THE X-RAYS
In 1901 was Nobel Prize Winner.
He was able to take a photo of the bones of his wife's hand with this rays.
Now we know that X-rays have many applications in therapy and diagnosis.
MORPHINE
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid.
Morphine was discovered as the first active alkaloid extracted from the opium poppy plant in December 1804 in Paderborn, Germany, by Friedrich Serturner. The drug was first marketed to the general public by Sertürner in 1817 as an analgesic, and also as a treatment for opium and alcohol addiction.
It acts directly on the central nervous system to relieve pain. There are many legitimate uses of morphine that make it a very important drug in the field of pain management. In the hospital setting, morphine is often used for pre and post operative pain management as well as in conjunction with the anesthesia used during surgical procedures. It is also used for pain management if a patient presents with traumatic injuries, such as those obtained during a car accident.
Sometimes morphine is prescribed by a doctor for use outside of a hospital. Patients who suffer from severe and chronic pains such as those associated with cancer, kidney stones or back pains may be take morphine to deal with the excruciating pain associated with their conditions.
The principal disadvantages are the tolerance and physical and psychological dependence develop quickly. Morphine was the most commonly abused narcotic analgesic in the world until heroin was synthesized and came into use. Withdrawal from morphine causes nausea, tearing, yawning, chills, and sweating lasting up to three days. Morphine crosses the placental barrier, and babies born to morphine-using mothers go through withdrawal
I think that morphine is a useful drug but people should use it only under medical prescription.
EPIDURAL ANESTHETIC
Perhaps one of the most important achievements for modern medicine is the development of the epidural anaesthetic. It consists of an injection into the epidural space (located on or over the dura madre) of the spine, as of an anaesthetic to control pain during childbirth. I think that this achievement is so important because it makes things easier for women. How many of them, at the moment of their childbirth, had to use general anaesthesia being not able to see their own labor or had to support pain to be able to see their childbirth? Nowadays this question is forgotten for most women, because they are both finally possible: see your childbirth without feeling pain. That must be great for each and every mother.
It’s usually placed when the cervix is dilated to four or five centimetres and woman is on true active labor.
Nevertheless is not as advantageous as it seems, epidural anaesthesia requires a high level of technical proficiency to avoid serious complications and is always given by an anaesthetist.
Although it’s very comfortable for mothers, some side effects could appear like a drop in blood pressure that’s why blood pressure must be controlated at frequent intervals during the labor. Another undesirable effect is headache which requires strong analgesia; the risk seems to be higher with younger age and larger size of needle. Finally the risk of paralysis is extremely low.
To sum up, epidural is a great achievement for women because, in spite of a few disadvantages, it helps to have a more positive labor experience, allowing mothers to be active participants.
HOSPITALSA hospital is an institution provided with specialized staff and equipment dedicated to the treatment of sick persons. Considering this definition, I think that one of the greatest achievements in medicine has been the apparition of hospitals. It seems a very basic idea, and we might think that hospitals have always existed, but that’s not quite true. Actually, the first real hospital was the “Hotel de Dieu” in Paris, and that didn’t occur until year 651 d.C. It is true that before that year there were some institutions, usually associated to monasteries, which were dedicated to the treatment of sick persons, but they didn’t really fit in the definition we give nowadays to the word hospital.
And why do I think that this has been a very important achievement? On one hand, hospitals have been a shelter for the weak, where they could rest and have some time to recover; and on the other hand, they have given the opportunity to specialized persons to observe illness from the proximity, and develop ways of curing through experience and empiricism.
Concluding, the apparition of hospitals demonstrates the interest of human being for the wellness of his own kind.
INFLUENZA VIRUS
The biggest events about etiology, prevention and treatment during the last XX century took place in the world of tropical diseases. The virus identification and the introduction of chemotherapy were essential for eradicate the Influenza pandemic, described in Europe since 1510 and responsible of more than 25 millions of deaths after the First World War. In 1933 the English Doctors Wilson Smith (1897-1965), Patrick Playfair Laidlaw (1881-1940) and Christopher Howard Andrewes (1896-1989) demonstrated the virical origin of the Influenza Pandemia and cultivated it succesfully in laboratory conditions.
Then it was possible to identify some immunological differences between the lineages A,B and C. In 1942 Thomas Francis (1900-1969) and Jonas Edward Salk (1914-1995) prepared the first vaccine against Influenza virus with poor results. In my opinion it is important to know that the Influenza Pandemic killed more people than the First World War so, the consequences of the war are always prolonged in the history. Sometimes in horrible conditions there is an opportunity for science to progress and help people.
ANTIBIOTICS
In my opinion, one of the greatest achievements in the whole history of medicine is the discovery and development of antibiotics, which began in the late nineteenth century. In common speech, the term “antibiotic” describes any substance that kills bacteria or inhibits their growth, but in the strict sense, this term refers only to those substances that are produced by microorganisms like fungi or bacteria. Nevertheless, in spite of the fact that some of these substances are still produced and isolated from living organism, most of them are now semisynthetic or even synthetic. It may be said that Paul Ehrlich was the pioneer in the story of antibiotic development. He discovered Salvarsan, an antimicrobial agent which was, however, quite toxic. Nowadays, thanks to the contribution of Fleming, Domagk, Florey, Chain and many others, there are a lot of these drugs available in the market, and they hardly cause adverse effects in comparison with the first ones. This development of antibiotics has permitted to control infections, which have caused so many deaths throughout the history. It´s certain that many people are still dying because of infectious diseases, because either they haven´t available drugs or they have a severe illness. However, many infections which probably would cause the death in the past are now cured without problems thanks to antibiotics.
IN VITRO REPRODUCTION
In honour of Robert Edwards, who recently received the Novel Price of Medicine and Physiology, I would like to talk about in vitro fertilization. He worked hard for this aim and his achievement made possible the first “test-tube baby” birth. Before this discovery, the privilege of “giving life” was reserved to God. But, fertilizing a human ovule became a fact in a laboratory. A step forward in this field made happy a lot of families that couldn’t have children, and it still happens nowadays. Nevertheless, these works arised polemic, they had a positive effect in society. He was very criticized by conservative and religious groups. He was even accused of pretending to be God. This ethical controversy damaged the development and the financing of the project. But thanks to private donations and without incentives for investment from the state, he continued to work.
Despite these problems, assisted reproduction made possible four million of children to be born. A science miracle.
ORGAN TRANSPLANTS
An organ transplant is a surgical operation in which a failing or damaged organ in the human body is removed and replaced by a functioning one. The first reasonable account for this achievement was skin transplantation in nose reconstruction by the Indian surgeon Sushruta in the second century B.C. with which came the problem of tissue rejection. Centuries later, as evidence of great progress, regenerative medicine promises to solve this problem by regrowing organs in the lab, using the patients' own cells! However, lots of other problems are unsolved: as the rising success rate of transplants and modern immunosuppression make transplants more common, the need for more organs has become critical. And this is one of the problems that should be discussed in a bioethical perspective. Modern surgery is giving thousands of people a new lease on life through the selfless altruism of others. Nevertheless, we are facing dilemmas such as: What are the sources of organs used in transplantation? Should alcoholics be given liver transplants? How do we decide who will receive the implants? Regardless, in my opinion, the transplantation of organs is one of the greatest miracles of Medicine because it has changed the end of thousands of life stories. “It’s a gift of a lifetime”. See for yourself:
http://www.organtransplants.org/
NON INVASIVE DIAGNOSIS TECHNIQUES
Possibly some of the greatest achievements in medical science have been “non invasive diagnosis techniques”, we are talking about those which are used in radiology. In 1895, the physics Wilhem Conrad Röentgen using the Crooke's tubes and a complex coil mechanism, managed to create X-rays. The rays strikes on photographic paper, making up the final picture (like a photo). The first picture using X-rays was his wife's hand. Nowadays, this apparently easy concept has become the pillar of powerful diagnostic techniques like Computered axial tomography (CAT or CT scan) or magnetic resonance imaging (MRI), which are essential in hospitals. The CT scan was introduced in the 1970s, but at the moment it is a very important tool in medical imaging, even its importance grows every day. We get a sectional image on different planes but the most used is transverse plane.
- It has many applications but on the other hand the risk of using CT scan is the radiation exposure (1 CT thorax scan is equivalent to 400 thoraxes X-ray). That’s the reason why the CT’s use must be very reasonable.
- Unlike CT, MRI uses no ionizing radiation. It uses the amount of hydrogen atoms of a tissue to draw the structure. The matter is that it costs much more.
Finally, I would like to say that radiology’s techniques are still rising and developing, this make easier diagnosis, screening or even treatment of diseases, but we can’t use it without responsibility.PENICILIN
Penicillin was discovered in 1928 by Alexander Fleming, who won the Nobel Prize in 1945. It was the first antibiotic substance on history, and it supposed a huge step in medicine´s development, because with antibiotics, several diseases that had an elevated mortality rate could be healed giving a new hope. The discovering was the result of a forgetfulness happened to Fleming when he was working at his laboratory. He forgot a colony of Staphylococci exposed to the air and it was contaminated by a fungus that destroyed a part of the colony with an antibiotic substance. An antibiotic is a chemical substance synthesized by an alive organism, and it has the function to destroy contaminants microorganisms such as bacterias or viruses, so these drugs were destinated to fight infectious diseases, increasing human´s survival and extending life. Since penicillin discovery, antibiotics had suffered a lot of pharmacological changes, and nowadays we have a big spectrum of drugs to combat microorganisms. The scientists Howard Florey and Ernst Chain also contributed to the development of penicillin, because they were the responsibles of commercialize it, helping people to get the drug when they needed it. Both of them shared the Nobel Prize with Fleming.
DNA
DNA is a molecule that can be found on the nucleus of every cell in a person’s body and has the instructions on how to construct and operate it. This molecule is ‘divided’ in genes, each of them has a piece of these instructions. Discovery of DNA is quite new, its study began in 1868 with Friedrich Miescher, a Swiss biologist who carried out the first carefully thought out chemical studies on the nuclei of cells but was in the next century, in 1943 that the first direct evidence of DNA as the bearer of genetic information emerged. This is an important achievement because the identification of genes in the DNA allowed for the improved ability to diagnose a disease, detect genetic predisposition to a disease, create new drugs and new therapies as treatment. All of this gives a chance to patients who had once untreatable illnesses. In the research area, the study of DNA and genes shed light on the cause and mechanisms of development of some diseases that prior to its discovery we had little information.
VACCINATIONS
Measles and Poliomyelitis are two diseases that killed millions of people in the past. Nowadays, diseases like those rarely cause victims, just because someone invented the vaccination. The word vaccination was first used by Edward Jenner, in 1796, when he saw that people who came in contact with the bovine virus, had a less severe disease. So, Edward started to apply the cowpox liquid on the skin lesions. Nowadays, vaccines are produced with attenuated or dead virus or bacteria and are inoculated into the human body, thus stimulating the immune system to produce antibodies against this antigen. Once vaccinated, if the person gets in contact with this virus or bacteria, his immune system is able to recognize them and remove them promptly. But, if vaccines offer more defences to the human body against some diseases, why do some parents refuse to give vaccines to their children? I think this can be related with two factors: a cultural factor and a fear of the vaccination risks. A cultural factor related with religious issues. Some religions don’t allow that ‘animal stuff’ should be introduced on the human body of their children (some vaccines are produced using animal serum). The fear of vaccination risks is very common, because despite vaccines having a wide safety margin, there is a low probability of complications. Anyway I think everyone should vaccinate not only because it’s better safe than sorry, but also because it helps to protect the entire community by reducing the spread of infectious agents.
ASEPSIS
In my opinion, asepsis has been a very important discovery in History. In the past, many people died because of infections; not infections produced by very pathogenic microorganisms, but just common germs that could have been easily eliminated with basis hygienic measures. One of the pioneers in this area was the Hungarian Ignác Semmelweis. He lived in 19th century, and he was the first doctor who said that many women who died after giving birth to their babies could be saved if the doctors who treated them washed their hands before. In spite of some publications that proved that the incidence of puerperal fever (the main cause of the high mortality among those women) decreased if doctors washed their hands before treating their patients, the medical community didn’t believe him. Until a few years later of Semmelweis’s death (he wounded himself with a scalpel previously used to cut a corpse, in order to prove he was right), when Pasteur published his research about microorganisms, the theory of Semmelweis wasn’t reconsidered. I think asepsis is important because it’s very related to the discovery of antibiotics, as it’s necessary to know first that pathogenic microorganisms exist if we want to fight them. Indeed, asepsis is a broad concept which is useful in almost any area of medicine: from healing of little wounds to prevent nosocomial infections in an invasive cardiothoracic surgery.
MICROSCOPE
For me, the invention of the microscope is probably the main argument to explain why life expectancy has grown up so incredibly in the last centuries. In the past, most of deaths and plagues were due to infections, but nobody knew that there were microorganisms who could attack us. Actually, even the existence of microorganisms was not known. Obviously, it was not possible to know it until Galileo Galilei (for the Italians) or Zacharias Janssen (for the Dutchmen) created the microscope in 1610. Not only the development of microbiology was then possible. Robert Hooke in 1665 made the first observation of cells, which were described later as the basic structure of living organisms: it was the birth of cellular biology and histology. Later, Anton van Leeuwenhoek described for the first time bacteria, spermatozoids, red cells and protozoos. He is considered as the founder of Bacteriology. Thanks to those inventions and observations were possible the development of antibiotics, vaccinations and a lot of another discoveries which have made our lives easier, and have controlled so many diseases, or even eradicated them. Without the microscope, none of this would have happened, because nobody would have ever discovered that microorganisms existed and were the main cause of millions of deaths and illnesses.
CHEMOTHERAPY
I think that the use of chemotherapy (any medical treatment based on the administration of chemist substance) is one of the most important achievement on the medicine history cause it has a really important and extensive use. The first chemotherapy treatment was invented by Paul Ehrlich in 1907 for the tripanosomiasis infection. Nowadays, chemotherapy is used for the treatment of tuberculosis, some autoimmune disease and cancer (one of the most extended disease of our times). The use of chemotherapy at cancer began in 1940 with the study of a chemist weapon used in the World War II, the mustard gas. Louis S.Goodman and Alfred Gidman were recruited by the Defense Department of the USA. They observed that people who died by mustard gas had a decrease of the lymph. So, they thought that this substance could be used to cure lymphomas. After a lot of experiments, they could demonstrate it. That was the first step of the demonstration that cancer can be treated by chemotherapy.
INSULIN
The discovery of insulin deserved the Nobel Prize in 1923, and it was a great advance in medicine. It's used for the treatment of diabetes, a chronic illness that affects 250 millions of people in the wide world, with 4 millions of deaths every year. The insulin is an anabolic hormone that allows the glucose capture( between other actions), and its failure produces high levels of glucose, hyperglycemia, that affects the whole body, specially eyes, kidneys, vessels and nervous terminations, with many complications that causes many deaths. Nowadays human insulin used in treatment is biosynthetic, thanks to engineering techniques using recombinant DNA technology that makes possible an insulin with less impurities, a very useful form that avoids allergies. The advantage of insulin is the different ways of administration: subcutaneous, insulin pump, inhalation, transdermal, oral insulin and also the fast action of the insulin after administration, that allows higher quality of daily life, because the patient can eat at not scheduled hour. But aren't all advantages, the great inconvenient is the risk of hypoglycemia and the other important inconvenient is that allows the treatment of DM type 1, where there is no pancreas production of insulin, but in DM type 2 there is a resistance at the action of insulin, so this treatment is not effective. But the advantages are more important than the disadvantages, and because of all the people that are treated with insulin and have a better life and as healthy as possible.
CORONARY CATHETERIZATION
"You certainly can't begin surgery in that manner"
In 1929, German cardiology intern Werner Forssmann was demoted from his cardiology internship to the urology one, because he allegedly didn't know how to start a surgery properly. In fact, he had settled the basements of a medical technique which has since probed useful in the study of haemodynamics, and the diagnosis and treatment of several heart conditions. He was awarded the Nobel Prize for Medicine and Physiology in 1956 for that discovery. What, however, was this either success or outrageous fact?
Pushing an urology catheter up the veins
Earlier that year, Forssmann asked a nurse in the Eberswald hospital for help: he needed access to some surgical instrumental, which she could provide. Then he sat on an operating table and anesthetized his forearm, and performed a phlebotomy in his brachial vein. As a next step, he pushed a urology catheter up his vein and 65cm far until he considered he had reached the right atria. Now, he stepped down the table and walked to the Radiology service, and shot himself a radiograph, to see just what he had thought: he had reached the cardiac chambers without performing any major surgery, but only a centimeters-small incision in his elbow. He showed his discovery at a congress, and his technique was seen as a valuable mean for measuring heart pressures, and also to deliver medicines directly to the heart.
What happened to Forssmann later? He joined the Nazi Army and was imprisoned in WWII by the Allies. After his release in 1945 he continued practicing medicine in Germany, becoming Professor at Düsseldorf and eventually winning the Nobel Prize in 1956.
Applications
By means of Forssmann technique (improved by Swedish radiologist Seldinger), cardiologists can perform certain diagnostics and even treatments, some of which are:
Haemodynamics
Doctors can measure the different pressures of the heart chambers, which is vital in the diagnosis of conditions such are valve diseases. It also allowed physiologists to understand the functioning of valves and the changes that occur in the cardiac cycle.
Coronary catheterization
Coronary catheterization has a diagnosis and a therapeutic side. One can see the status of the lumen of coronary arteries, detecting any possible narrowing or occlusion that affects the adequate blood supply of the heart. The therapeutic use is, maybe, the most dramatic use of Forssmann’s technique. Now can doctors treat severe and critical diseases as are myocardial infarction or other forms of sudden cardiac arrest / acute coronary syndrome (ACS), as well as stable angina (chronic chest pain). As of 2008 more than one of these so-called angioplasties per mile inhabitants and year were performed in Spain. Some trials show that more than 90% of ACS patients intervened with angioplasty survive the episode of hospitalization. This technique can be performed also in other arteries, such as the arteries in the brain, kidney, and neck (cerebral, renal and carotid angioplasties).
ANAESTHESIOLOGY
One of the greatest achievement of medicine was undoubtedly anaesthesiology, due that since the beginning of the medicine has been looking for ways to eliminate pain. The first methods used was narcotics as mandrake, the during Middle Age was used henbane like local anaesthesiology. But it wasn’t until 1842 when Dr. Crawford Williamson Long used anaesthesia in a surgical intervention like a method of pain inhibition. He used ethyl ether. However, the discovery of anaesthesia is attributed to Dr. Morton in 1844. He built a gadget that allowed the administration of ether. After that, chloroform was quite used because of its greater efficiency in the sedation of pregnant women during childbirth. Since then, many anaesthetics have been discovered and, over the years, more and more powerful. Nowadays, anaesthetics have others utilities besides surgery like inhibit pain in endoscopy, interventional radiology, treatment of patients with cancer, etc. In conclusion, anesthesia is a medical procedure in which is used drugs to block touch or pain of a patient, either in whole or part of its body and be with or without impairment of consciousness.
ANTIRETROVIRAL DRUGS
Antiretroviral drugs were developed to be used for the treatment of infection by retroviruses, as everybody knows the most famous retrovirus is HIV, which causes a disease called AIDS. This disease is responsible for millions of death all over the world, mainly in developing counties. However, AIDS is no longer synonymous with death. Thanks to recent advances in antiretroviral drugs, in developed countries, HIV infection is almost completely controlled. For this reason, many researchers are going for that line of research. Suddenly, the HIV infection ceases to be a disease with very poor prognosis to be simply a chronic disease, and all this is the work of research of the disease and the improvement in antiretroviral drugs.
WINDOWS AT HOSPITAL
Everybody talks about a lot of discoveries, chemical substances or new techniques in medicine, but none of them have noticed some basics as windows at hospitals!!. Some years ago, as my mates have explained before, it was discovered lots of small cells that cause very dangerous diseases called microorganisms. Medical practice taught them (doctors), these little cells could be transported by thousands forms from people to people. For example, they realized that TBC (Tuberculosis) could be infected through the air. That was the reason why doctors decided to install these patients at special hospitals hoping not to infect more people. BUT they thought keeping windows shut would reduce the transmition to healthy people, and they did not pay attention to the fact that if they were always together, breathing the same contaminated air, they would not be able to cure anything!!Nurses opened windows as less as possible, because it was assumed that diseases would go out of the hospital and infect other people. But one day, by chance, they noticed that patients installed in a room with a broken window cured much faster than other patients. They studied these cases and saw that all their infections were reduced mainly because windows were sometimes open.
STEM CELLS
Stem cells have the potential to develop into many different cell types in the body; and in some kinds of tissues they participate in internal repair systems. They have got some particular characteristics that differentiate them from other types of cells: - They are unspecialized cells which can proliferate and renew themselves, so they can keep the group of cells that make up a tissue. - They can give rise to specialized cells. - They can regenerate a tissue or even an organ under certain physiologic or experimental conditions.
There are different kinds of stem cells depending on their origin: embryonic cells which come from blastocyst; fetal cells originated in fetal blood, liver or lung; and somatic or adult stem cells that form part of several tissues (bone marrow, brain, skin, skeletal muscle, teeth, liver...). According to their potential to generate specialized cells, the embryonic ones have got more capacities than adult stem cells.
From my point of view, they are one of the greatests medical achievements due to the possibility of tissue regeneration. Stem cells are an opportunity for thousands of illnesses whose medical or surgical treatments are not effective, as well as a new tool in organ transplants.
At this moment they are being used in treatments of several pathologies: bone marrow transplant (the first one was made in 1968), autologous skin grafts, corneal reconstructions, diabetes… The research to find out their new opportunities or applications and to improve their use in humans continues unabated.
THE STETHOSCOPE
One of the most important achievements in the practice of Medicine was the invention of the stethoscope. The stethoscope was invented in France in 1819 by René Théophile Hyacinthe Laënnec. In the 19th century the only way of listening the cardiac sounds was to bring the ear close to the patient's chest. One day, Laënec was exploring a patient whose husband and mother were in the same room. He realized that her patient was too embarrassed, so he decided not to place directly his ear on his patient's chest in order to make her feel comfortable. So he took a notebook, rolled it, and put it on his patient's chest. He approached his ear and listened the heart beating as he never did before. That day he ordered to a carpenter to make a wooden cylinder of 30 cm long that would turn into the first stethoscope. Nowadays the stethoscope is composed of two rubber tubes that finish in two structures that you put in your ears. This two rubber tubes are also connected by the piece that you place on the chest. The stethoscope is one of the most useful diagnostic tools for the physicians. It allows them to explore both the cardiovascular system and the respiratory system, making possible the diagnosis by auscultation. Nowadays it is impossible to imagine the exploration without the use of the stethoscope.
PLASTIC SURGERY
Plastic surgery is a medical branch whose purpose is the rebuilt or restoration of different structures of the body that have been damaged. It includes several disciplines such as reconstructive surgery and cosmetic surgery. They both have many applications we will pay attention to below. The origin of plastic surgery is supposed to be hundreds of years before Christ (500 b.c.). It was in India where the first documents about plastic surgery were found. They belonged to the book Sushruta Shamita, written by Sushruta. Sushruta was the father of nose surgery (which is called “Rhinoplasty”). He used flaps to repair the destruction of nose. In India, nose was considered a very important organ. It was a sign of respect and importance. That is why it was very common to rip it off to the criminals as a way of punishment. Plastic surgery progression was strongly linked to the development of general surgery, anesthesia and antibiotics. They are so close, that plastic surgery would have never been possible without them. This is because it needs the processes of general surgery, and it is vital to prevent patients from pain and infections. One of the most famous procedures in plastic surgery is the “skin grafting”. In consists in take a little piece of skin from the patient body or other person, and put it in the place of the damaged zone, so that the defect can be hidden. There are too many techniques such as laser or microsurgery that can be also very useful in surgery treatment. Coming back to the different disciplines of plastic surgery, we have to make reference to cosmetic surgery and reconstructive surgery. The so called cosmetic surgery is totally up to date. It is not strange to see all the Hollywood stars with their perfect lips, breasts or noses and with hardly wrinkles in their faces. Nowadays, if you have money, you can perfectly use these treatments to get an extraordinary aspect, but I think plastic surgery is a great technique and it should be used to cure real disorders. Reconstructive surgery is one of the most important achievements medicine has ever managed, and that´s why I´ve chosen it as my topic. It is created to correct different disorders caused by traumatisms, burns, facial bone fractures, congenital abnormalities, tumors, etc. Some of the more common procedures are breast reconstruction after a mastectomy, hand surgery, scar treatment, and an endless list of techniques. It is very important because let people recover the function or appearance they used to have before an accident or another traumatic event. We mustn´t forget the psychic implications that every alteration of the body have, and that can be avoided with reconstructive surgery.
Non-steroidal anti-inflammatory drug (NSAIDs)
In my opinion, NSAIDs are an important achievement in medicine, because they are able to help in the treatment of multiple diseases.
NSAIDs are chemical substances with analgesic, antipyretic and anti-inflammatory effects. For this reason, they reduce inflammatory symptoms, and relieve the pain and the fever respectively. In this group of anti-inflamatory drugs are included popular medicaments as ibuprofeno, aspirine or paracetamol.
Mechanism of action: All drugs of this group work on the enzyme cyclooxygenase (COX), decreasing the production of prostaglandins, which participate in inflammatory process. John Vane, who later received a Nobel Prize for his work, elucidated this mechanism of action. Many aspects of the mechanism of action of NSAIDs remain unexplained, for this reason, further COX pathways were hypothesized.
NSAIDs are usually indicated for the treatment of acute or chronic conditions where pain and inflammation are present. For example: rheumatic diseases, gout, dysmenorrhoea, headache, fever, postoperative pain, renal colic…
Some of the advantages of this group of anti-inflammatory drugs are:
- Do not produce respiratory depression.
- Do not cause psychic or physical dependence.
- Do not envelop tolerance.
On the other hand, we have to say that NSAIDs also could produce some adverse effects in specific situation. In general, they e very insurances, but they can cause for example digestive haemorrhages, peptic sores, photosensibility, or premature birth in pregnancy women.Studying this information, we realize that NSAID provides us a useful tool to improve vital condition of patients without negative important repercussions.
HUMAN GENETICS THERAPY
I am going to deal with this topic because it is an excellent tool in healthy field all over the world, although it is not completely developed.
It is fundamentally considered as a deliberate administration of genetics material in a human patient with the purpose of delating a specific genetics defect or giving to the cells a new function. This administrated genetics material is normally a working gene.
Actually, it goes back to 1,990, when W. French Anderson proposed the use of marrow cells that had been treated with a retroviral vector within a correct copy of 'adenosin desaminasa' enzyme gene. It was applied to the treatment of SCID (a disease where this enzyme is mutated).
Bassically, this therapy needs the knowledge about how different mechanisms control the correct function in genes. Fortunately, it gave to us some good expectations in the attemp of preventing and treating different diseases, whose cause is located in DNA.
On the one hand, it is definitely an extremely good advance for health all over the world because like the italian doctor Pablo Argibay pointed out, this therapy will be usefull to improve interventionist medicine in the near future. Nevertheless, it will be really usefull when we will be able to know the expression, regulation and duration of the action of these therapeutic genes.
On the other hand, genetics therapy has numerous problems to evolutionate in an easy way. Firstly, science field would need to discover, understand and explain many other unresolved questions.
To sum up, I would like to remark that this tecnique has not been developed at all, but what is a really amazing advance is that we know how we will be able to make a good improve in science. Now, we don't only need to develop other fields, but also necessary money will have to be raised, which will not be an easy task to do.
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BLOOD TRANSFUSION
Blood transfusion is commonly defined as the process of transferring blood (or blood-based products) from one individual (donor) to another (recipient).
This process is one of the most important achievements in the history of medicine because it can save life in some situations (characterised by massive blood loss) or used to replace blood lost during surgery. Nowadays, it is widely admitted that if it were not for this discovery, human being would not have been able to make organ transplants.
It is believed that the first blood transfusion was made, a long time ago, by Australian aborigines. Sometime later, in 1665, the English physician Richard Lower kept a dog alive by transfusing blood from other dogs and in 1667, Jean-Baptiste Denis in France carried out the first successful blood transfusion from sheep to humans: he transfused the blood of a sheep into a 15-year old boy who, incredibly, survived the transfusion.
In 1818, the British obstetrician James Blundell performed the first successful transfusion of human blood to a patient for the treatment of postpartum haemorrhage and in 1840, Samuel Armstrong Lane, aided by James Blundell, carried out the first successful whole blood transfusion to treat haemophilia.
Almost a hundred years after, Karl Landsteiner, an Austrian physician, discovered the first three human blood groups (A, B and 0) and in 1906 Reuben Ottenberg developed the first blood transfusion using blood typing and cross-matching. These new achievements made safer the blood transfusion because the coagulation problems could be avoided.
Nowadays, blood transfusion is an essential element of modern health care. However, it may be used correctly, in order to minimize the risk of transmission of infectious agents, such as HIV, hepatitis B and C viruses, syphilis or Chagas disease.
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The first implant of a pacemaker (1958)
I think that one of the most important achievements for Medicine has been the PACEMAKER.
In the century XVIII, after the discovery of the electricity, the electrical implication was studied in the muscular contraction.
In 1855, the Frenchman Guillaume Duchenne de Bologne managed to stop a tachyarrhythmia of a 21-year-old patient who was affected of diphtheria, with the “electrical hand”.
The definitive development of the pacemaker was achieved by Hugo von Ziemsen, a German who demonstrated in 1882, that in an alive person, the ventricular activity is controlled by electrical impulses.
Albert Hyman tried it with an artificial pacemaker.
The experiences of Paul M.Zoll and Ake Senning, were the total success of the electrotherapy for diseases of the cardiac rhythm: Zoll implanted the external one, and Senning the internal one two years later.
The lucky patient was 40 years old, and thanks to the operation, it corrected a blockade atrioventricular.
And finally, we can say that thanks to the pacemaker which activates with electrodes the cardiac muscle, a lot of people with cardiac diseases, indeed get to have a better quality-life.
IN VITRO FERTILIZATION
I think that one of the most important achievements in medicine could be the development of "in vitro fertilization".Such is its importance that the discoverer, Robert G. Edwards, has been recently chosen for the Nobel Prize in Physiology or Medicine this year.
Nearly 4 million babies were born as a result of the technique when families found problems in conceiving a child.
Nowadays, lots of couples benefit from this achievement and are able to bring new life to this world. However, it is worth to mention that this achievement is not totally perfect. There are several controversial believes and thoughts that involve it... all the cells created to bring life are not always used to continue the process and are eliminated. That's why many people rise against this practice. Is it moral or not? That's the question to answer...
THE THECHNOLOGY IN MEDICINE
One of the most important achievement in the field of medicine is the improvement of the technology that allows the reseachers to be able to get the cure of many diseases. Besides, this improvement has been also used to the diagnose and operations (robots, laser surgery...) by the doctors.
Some examples of the technology used in medicine are:
- X RAYS: the x rays were discovered by Wilhelm Conrad Roentgen. They are a useful technique that allows us to detect especially bones diseases, besides others. The X Rays are so important that currently an specialization is devoted to the study of its images: the radiology.
-DEFIBRILLATOR: is one of the most used and the most important objects of the cardio pulmonary resucitation (CPR). There are several types, one of them is the automatic external defibrillator. This one allows diagnoses and treats a patient with a heart failure due to the heart has an electric activity but not mechanical. If the machine detects this failure then it will administer an electric impulse to the heart, this impulse makes the heart recover the normal heart rhythm.
-PACEMAKER: it is a small machine that implants in the patients whose heart has not an adequate rhythm. This machine generates electric impulses when detects an inadequate rhythm and frequency. The pacemaker when generates these impulses makes the patient has a normal hearbeat.
-PROTHESIS: they can be external (like arm prothesis) or internal (like hip prothesis). It consists on implanting an artificial limb due to the original one has been mutilated, amputated, broken or even deteriorated. What is looked for with the prothesis is recover the functionality of the original limb. In some cases this objetive is achieved,like the leg prothesis, but on the other hand there is another ones that because of complex functions that carries out is more difficult to create these prothesis.
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X- RAY DISCOVERY
This tecnique was discovered by Wilhelm Roentgen, and it suppossed a step forward in the history of medicine. This techonlogy gives the doctor the posibility to make visible the internal structures of the body without the necessity of surgery
X-ray is a very useful diagnostic tool, is used for taking images of internal structures.
In case of radiography, that works with this X-Rays, is oftenly used for the diagnostic of skeletal pathologies, but also is used in the diagnostic of other pathologies such as kidney stones or lung problems.
Other kind of test that works with this X-Rays technology is Computed Axial Tomography (CAT) wich is better for taking images of soft tissue.
This tecnique has a very important problem, because some studies have considered X-rays as carcinogen, and that is the reason because the persons who practise the test need protection.
Nowadays, this tests are very often used in the diagnosis of common diseases and that is why, in my opinion, the discovery of X-Ray by Roentgen is an important achievement in Medicine.
ETHICAL COMMITMENTS
There have been a lot of medical achievements and discoveries, but from the beginnings of medicine the human being's inherent questions have not been answered and nowadays these questions are present in general medical practice.
Thanks to the ethical commitments, the questions involving the morality can be answered by a group of experts in those topics. Things such as to make a medical abort, euthanasia, and how to deal with patients in certain circumstances are very polemic. Since the existence of ethical commitments, doctors involved in those moral discussions are supported by the opinion of the experts.
The ethical commitments are not only useful in the usual practice of the doctors. All the investigations of these years are also supported by them. A lot of discoveries until the middle of last century, in spite of the benefits of the achievements, have been non-moral and it worked against some people. Currently the investigations, supported by these commitments, do not threaten people's moral integrity.