Munchausen and Munchausen by proxy Syndrome

So, I have to devise a piece of drama as a part of my drama GCSE and as a group we were thinking to touch on the issue of Munchausen by proxy syndrome. I did some research on Munchausen and Munchausen by proxy and I thought that i’d share it here…

Munchausen Syndrome

This is a serious mental disorder in which a person pretends to be sick or make themselves sick or injured as they have a deep need for attention. They may make up symptoms, push for risky operations or rig laboratory test results in order to gain sympathy or concern People with Munchausen syndrome go to great lengths to avoid discovery so it is very hard to determine whether these people are suffering from a severe mental illness. This disorder is different to that of hypochondria who truly believe they are sick, because people with Munchausen’s want to be ill.

Some symptoms may include:

  • Dramatic stories about numerous medical problems
  • Frequent hospitalizations
  • Vague or inconsistent symptoms
  • Conditions which get worse for no apparent reason
  • Eagerness to undergo frequent testing or risky operations
  • Extensive knowledge of medical terminology
  • Seeking treatment from many different doctors or hospitals
  • Arguing with hospital staff
  • Frequent requests for medication

People with Munchausen syndrome may be well aware of the consequences of the self-harm they seek but are unable to control their compulsive behaviour and are unlikely to seek help. Usually, people with this disorder will go to great lengths in order to be seen as sick as they have such deep emotional needs. It is common that they have other mental disorders as well. The cause of this illness is unknown, however it is possible that people with this disorder may have experienced a serious illness when they were young, or may have been emotionally or physically abused.

Munchausen by Proxy Syndrome

Munchausen by proxy syndrome (MBPS) is different in that someone makes another person ill in order to win sympathy. This usually involves a parent causing or fabricating symptoms in a child. Sometimes, after deliberately misleading others (medical professionals), they may go as far as to actually harm the child through poisoning, medication or suffocation. In 85% of cases, it is the mother who is responsible. Some experts say that it is the attention gained from the ‘illnesses’ of the child that drives them to do such things, but it is also the satisfaction in deceiving others that they consider to be more important than themselves. In some cases of MBPS, the perpetrators were themselves abused as children and they may have come from families in which being sick was seen as a way to get love. There have been a number of serious cases in which a child or children have died as a result of Munchausen by proxy, one being the story of Marybeth Tinning.

Marybeth Tinning suffered from acute Munchausen by proxy and smothered her 3 month old baby in 1985. She is also suspected of murdering her other eight children, all of whom died of suspicious causes. She is currently serving the 20 year sentence of the murder of her daughter. Some of the cases where her children supposedly died of SIDS (Sudden Infant Death Syndrome) have now been seen as suspicious as where she claimed they turned blue after their deaths; it is now known that a child who is a victim of SIDS would look normal after they had died. If the baby was blue, Dr Michael Baden suspected the child died of homicidal asphyxia (smothered to death). Marybeth Tinning seemed to enjoy the attention she received at her children’s’ funerals and this may have caused the deep need for more attention.

Marybeth Tinning

Marybeth Tinning

More of her story can be found here:

Trick or Not So Treat

pumpkins

Halloween season may be considered a time of fun and games for most people but in a hospital, things can get a little out of hand (no pun intended). According to the Student BMJ, Halloween is among the four most likely days of the year that children will be admitted to the emergency department.

Carving pumpkins is one injury related to this annual event and it has caused many injuries to arise.

The most common injuries that orthopaedic surgeons face as a result of using a knife are deep puncture wounds and lacerations to the hand

deep puncture wound and laceration

These are caused by the knife being pushed too far accidentally. Cutting the taut flexor tendons in the palm is a potentially devastating trauma (it can make it impossible to move one or more joints in a finger). Because tendons connect the muscle to the bone, they are under tension which means that when they are cut or torn, they pull far apart making it impossible for them to heal on their own.  Immediate surgery may also be required if the knife were to cut a blood vessel in the hand which would prevent the fingers from having a blood supply.

Also, on this night, the number of assault victims also increase leading to more injuries. According to Dr Glatter, other hand trauma is caused by factors that are not just confined to pumpkin carving.

  • Fracture of the fourth or fifth metacarpal is common (also known as “boxer’s fracture”). These are most commonly caused by the impact of a closed fist with a skull or hard, immovable object such as a wall. The knuckle compresses and snaps the neck of the metacarpal bone.
Metacarpal Fracture

Metacarpal Fracture

  • Fight Bites are when the punch recipient’s tooth breaks the skin, which can easily lead to a high risk of infection. Because of this, these injuries are much more serious than they first appear to be.

fight bites

The costumes that people wear when they go ‘trick or treating’ can potentially be very harmful in themselves. In 1997, Sunil Choudhary published a case where a teenager was left with severe extensive burns that covered 15% of his body after wearing a mummy costume made out of toilet paper that came into contact with a candle.

Also, decorative and cosmetic contact lenses can be very dangerous if they have not been approved. Contact lenses under poor quality control can lead to infections and risk damage to the eyes during application. People who wear cosmetic lenses are at a greater risk of developing acute infections that can threaten one’s vision due to the poor lens hygiene but also the inexperience of the application of a lens which leads to corneal scrape trauma. In comparison to those who wear prescription lenses, cosmetic lens wearers have an increased chance of developing microbial keratitis.

Keratitis is an inflammation of the cornea which sometimes occurs with infection after bacteria, viruses or fungi enter the cornea.

Symptoms of Keratitis include:

  • tearing
  • pain
  • sensitivity to light
  • inflammation of the eyelid
  • decrease in vision
  • redness

coloured contacts

These are just a few things that can go wrong on this night… Happy Halloween everyone 😉

All About Anaesthesia…

The literal translation of anaesthesia is ‘loss of sensation‘.

anaesthesia

Anaesthetics are the medications used that cause anaesthesia which are used during tests and surgical procedures. Anaesthetics block the signals that pass along your nerves to your brain; after the anaesthetic has worn off, the nerve signals will be able to reach your brain and your feelings will return.

Types of Anaesthesia

There are a number of different types of anaesthetic and only general anaesthetic makes you unconscious.

  • Regional anaesthetic:- used for larger/deeper operations where nerves are more difficult to reach (this is commonly used for Caesarean sections). Only ever conducted in an environment where a team is able to easily provide general anaesthesia if necessary.
  • Epidural anaesthetic:- a type of local anaesthetic usually used to numb the lower half of the body. A needle is used to locate an area of the spine known as the ‘epidural space’ and can numb areas such as the thoracic area (chest), abdomen, pelvic area and legs
  • Spinal anaesthetic:- type of regional anaesthetic that is used to numb the nerves of your spine so that surgery can be performed in this area.
  • Sedation:- sometimes used for minor procedures- a sedative relaxes you physically and mentally.
  • Local anaesthetic:- used to induce the absence of sensation in part of the body ( local insensitivity to pain). Anaesthetics sometimes combine both local and general anaesthesia techniques.
  • General anaesthetic:- a drug that has the ability to induce a reversible loss of consciousness. These are given to a patient in order to facilitate surgery so that they don’t feel any pain

There are a number of theories about how general anaesthetics work, however, the precise mechanisms remain unknown.

Side Effects

Anaesthetics consist of a number of medications that can cause side effects in some people.
These are some of the side effects of general or regional anaesthetics:

  • Nausea or vomiting (1 in 3 people feel sick after an operation)
  • Sore throat
  • Aches and pains
  • Dizziness
  • Blurred vision
  • Headache
  • Itchiness
  • Bruising and soreness

These side effects do not last very long and can be treated with further medication if necessary.

Risks

Anaesthesia has become much safer over the years and advances have meant that serious problems are uncommon.
However, there are always potential complications:

  • Permanent nerve damage (cause numbness or paralysis)
  • Anaphylaxis (serious allergic reaction)
  • Death (approx. 5 deaths for every million anaesthetics given in the UK).

History of Anaesthesia

Thankfully, anaesthetics have been developed and so now they are used commonly under safe situations. However, it has not always been like this.
The concept of anaesthesia has been around since they have been performing surgery.

Early anaesthetics such as soporifics (which dull the senses and induce sleep) and narcotics (including opium, mandrake, jimson weed, marijuana, alcohol and belladonna) were all used as substitutes of today’s drugs. Although all of these can provide some pain relief, sedation or amnesia, there were no guarantees.
In mid 1840s, opium and alcohol were the only two substances used regularly as anaesthesia in industrial countries. There were many negative side effects to using these:

  • Patients could easily become addicted
  • The doses needed to provide the amount of pain relief/ sedation could easily result in death.
  • Surgery usually resulted in the tortured screams of patients because the anaesthesia wasn’t good enough.

1845– Dr Horace Wells was the first person to use nitrous oxide to pull teeth out

Dr Horace Wells

Dr Horace Wells

1846– Dr William Morton removed a tumour for the jaw of a patient. He used a sponge soaked in ether and the patient claimed he had no memory of the surgery or any pain.

Dr William Morton

Dr William Morton

Chloroform was first used as an anaesthetic in the mid 1840s by Dr James Simpson. It is highly toxic and so ether was used instead in the early 1900s.
Using a sponge made it hard to control the dosage and therefore, nitrous oxide is now used as an inhalable gas. Anaesthesiologists administer the drugs via machines that measure the specific amount necessary for each individual patient.

Because the drugs interfere with breathing, patients are often intubated- a plastic/ rubber tube is inserted in the trachea to keep the airway open- and then, during surgery, the patient is kept on a mechanical ventilator.

general-anesthesia-coma_1

Gamma Saves Lives

Today in Physics we were learning about radiation and one thing in particular was mentioned that I found particularly interesting.

Because cancer cells are the most vulnerable to radiation, radiotherapy is used as a way to get rid of certain tumours. We learned about the ‘Gamma Knife’ which is a non-invasive procedure that can be used as an alternative to open surgery; especially if the tumour is very hard to operate on due to its size or positioning (especially if it is in the brain).

This treatment fires 200 rays of gamma radiation from different angles to the tumour which destroys it, leaving a very low risk of ionising surrounding healthy tissue. Such a high dose is needed as gamma radiation is not very ionising, however, due to the fact that the rays are fired from different angles, it results in a very low dose of radiation around the tumour.

rays gamma

Gamma knife can treat a number of different conditions including:

  • benign, malignant or metastatic brain tumours
  • vascular malformations – this is when some of your arteries and veins in your brain are connected in ways they would not usually be
  • other disorders such as trigeminal neuralgia and Parkinson’s disease

The procedure isn’t suitable for tumours larger than 4 to 5cm and it is a very accurate procedure as it has precision of less than a millimetre.

Steps in preparing for Gamma Knife Treatment:

  • A light-weight frame is fitted to your head and local anaesthetic is injected into four sites on your head where it will be fitted with pins.
  • An MRI (magnetic resonance imaging) will be taken to identify the exact place that needs to be treated. You may also have a cerebral angiogram (an X-ray image of the blood vessels in your head and neck) if the treatment is for a vascular malformation. Occasionally, your doctor will recommend a CT (computerised tomography) scan. A CT scan uses X-rays to make a three-dimensional image of part of the body.
  • The images taken by CT, MRI or angiography will be fed into a computer that calculates the exact treatment time and dose of radiation needed.
  • The radiographers will leave the room after you are fitted into the machine and the whole process can take up to several hours.
Gamma Knife

Gamma Knife

Advantages of Gamma Knife:

  • There are very few side effects as it only targets the affected areas
  • There are less risks than open surgery
  • No general anaesthetic is needed (no risks from that)
  • No infection after surgery

This procedure has a 90% success rate which I would consider very good 🙂

Results Of Gamma Kife

Results Of Gamma Kife

Oakhaven End of Life Workshop

Today I visited Oakhaven Hospice for an End of Life workshop where we looked at the different ways the hospice and its association can provide support for patients, carers and families who are facing complex physical, emotional and practical difficulties arising from advanced progressive life limiting illness.

Oakhaven Hospice

Oakhaven Hospice

We looked at what a hospice really means and despite the many pre-conceptions, it is actually a place that feels alive and focusses on the positive; I was also quite surprised to find that the place is filled with lots of laughter and joy despite the morbidity of their situations. Oakhaven alone provides care for approximately 100,000 people living in the New Forest and Waterside areas.

We looked at a quote that I thought was very true, especially from personal experiences; it was

“How people die remains in the memory of those who live on.”

–          Dame Cicely Saunders

If a person has a pleasant peaceful death and has fully accepted or tried to accept what is happening to them then it is a much happier time for everyone. However, when the treatment of that person is very poor and they are so scared for what is to come for them and what they are leaving behind, then the experience can be much more unpleasant. Oakhaven Hospice provides counseling for patients and their families in order to prepare them for the inevitable and that can really help them to pass more peacefully.

After the introduction to the work of the hospice, we split up into smaller groups and took a tour of the hospice. I had already visited when I helped out at the Family Fun Day, helping to raise money, but this time we were able to speak to staff and patients along the way. We talked to a nurse from the care agency who would take regular checks of patients in their home and determine whether they should come to the hospice and what sort of care they would need.

Then we visited the in-patient unit where we looked at one of the rooms and all of facilities that were available to anyone coming in to stay. They said that a patient would usually stay between 1-2 weeks before going home again or deciding to stay to die. The lady in charge said that she thought dying is the last choice we ever make which I think is beautiful. She said that it is very similar to fainting as in that moment when you think you are going to be pulled into unconsciousness; you have the power to will yourself back even if it is for a just a few more seconds. She told us that she has had patients hold on, despite the odds, until their family came to visit them or hold off until their family member left the room for a couple of minutes to go to the toilet. Perhaps they would not have been able to willing leave them if they were right there. I found all of the stories she told us quite fascinating.

After that, we saw the chapel and talked with a member of the chaplaincy, a physiotherapist and someone from the team that welcomed volunteers. After talking with them, I had the privilege to talk with one of the patients carers during lunch and it was very interesting to hear of how her life changed from just a single turn of events. It came to my attention that the concept of total care is the importance of being devoted to the person rather than the disease; all of the patients were very comfortable talking about their illnesses and preferred that we talk to them directly about it rather than keeping it to ourselves.

As well as all of this, we also discussed what it would be like if we had a disease that could prevent us from doing the day to day things, not just from being  physically unable but from the emotional trauma that can also haunt a person, and we also learnt about having difficult conversations with patients and the importance of communication.

I feel like today was a very valuable experience and I am glad that I attended; hopefully I can take what I have learnt into my future and become a more compassionate doctor.

Alzheimer’s Disease

Today there was an article on the BBC News website that claimed that copper was a contributor to the Alzheimer’s disease. According to an article in Proceedings of the National Academy of Sciences they are in very early stages of testing (they are still looking at the effects on mice). However, they have found that the amount of copper given to the mice in their water has affected the aging brain vessels as it interfered with the production of a protein called amyloid-β. This could lead to the accumulation of the protein over the blood–brain barrier (BBB) which is neurotoxic (poisonous to nerve tissue).

One of the characteristics of Alzheimer’s disease is the formation of plaques of amyloid in the dying brain. Despite this, Dr Eric Karran, from Alzheimer’s Research UK, said:

“While the findings present clues to how copper could contribute to features of Alzheimer’s in mice, the results will need replicating in further studies. It is too early to know how normal exposure to copper could be influencing the development or progression of Alzheimer’s in people.”

This article got me thinking; other than the fact that alzheimer’s is a form of dimentia, I don’t really know that much about it and therefore I decided to look into it further.

Alzheimer’s disease was named after a German psychiatrist and neuropathologist Alois Alzheimer in 1906 and is a disease that will eventually lead to death and is predicted to affect 1 in 85 people globally by 2050.

Alzheimer’s disease is a progressive brain disorder that causes a gradual loss of higher brain functions, such as memory, language skills, and perception of time and space; eventually these lead to the inability to care for oneself. Unfortunately, these symptoms are irreversible.

A primary cause of Alzheimer’s is the deposits of the protein amyloid-β which forms plaques in the brain. When many amyloid-β peptides (short chains of amino acid monomers linked by peptide (amide) bonds) come together, they form an insoluble piece of protein called an amyloid plaque.

amyloid plaques

amyloid plaques

The exact cause for Alzheimer’s is unknown, however, there are a number of factors that can increase the risk of it occurring:

  • increasing age
  • a family history of the disease
  • previous severe head injuries
  • lifestyle conditions associated with vascular disease

Because Alzheimer’s disease gets worse as it progresses, symptoms are also more severe the further along it has progressed.

Early symptoms include:

  • minor memory problems
  • difficulty saying the right words

These symptoms can lead to:

  • disorientation
  • personality changes
  • behavioural changes

There is no single test to identify Alzheimer’s disease but hopefully in the future, according to this article, there may possibly be.

Advanced medical imaging such as computed tomography (CT) or magnetic resonance imaging (MRI), and with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) can be used to help exclude other cerebral pathology or subtypes of dementia. Moreover, it may predict conversion from prodromal (early) stages (mild cognitive impairment) to Alzheimer’s disease.

PET scan of the brain

PET scan of the brain

It is usually diagnosed clinically based upon patient history, collateral history of relatives, and clinical observations based upon the presence of neurological and neuropsychological features.

differences between the brains with and without alzheimer's

differences between the brain with and without Alzheimer’s

Alzheimer’s is a disease that can be hard both on the patient and the family of the patient and I hope that I will never have to go through a situation where I have to see a family member who is not really there. I highly respect those who do.

Thanks again,

Rachel.

Chronic Myeloid Leukaemia

In my spare time I like to write and in the past I haven’t been very successful in continuing stories and I think that is because I didn’t do enough planning to sustain a good story line. Therefore, this time I have decided to change that; my current story is based around a boy with Chronic Myeloid Leukaemia and I did my research on this illness and thought I might as well share my research with everyone.

Chronic Myeloid Leukaemia (CML) is a cancer of the white blood cells in the bone marrow. It is when there is an increase of white blood cells which accumulate in the blood therefore interfering with the production of healthy blood cells which are needed to fight infection. Eventually the body doesn’t have enough red blood cells to supply oxygen, enough platelets to ensure proper clotting or enough normal white blood cells to fight infection making people susceptible to bruising, bleeding and infection. The word ‘chronic’, when talking about leukaemia, means that it develops and progresses more slowly (over months or years even without treatment).

chromosome9and22CML develops due to a problem with a stem cell in the bone marrow which becomes abnormal. Every person has 23 pairs of chromosomes and CML occurs when a piece of chromosome 22 breaks off and switches places with a piece of chromosome 9. The piece containing both parts is known as the Philadelphia Chromosome which results in the cancer gene BCR-ABL; this is what instructs the body to make too many white blood cells.

philadelphia chromosome

The ultimate cause of CML is unknown and although it is caused by an abnormal gene, the disease is not inherited.

Symptoms

Ususally patients with Chronic Myeloid Leukaemia are asymptomatic (present with no symptoms) and are diagnosed after a routine blood test but some symptoms may include:

  • enlarged spleen causing pain on left side (due to the fact that cancerous cells can also develop here as white blood cells are produced there)
  • malaise (a feeling of general discomfort)
  • low grade fever
  • bone and joint pain
  • easy bruising
  • recurrent infections (bronchitis/tonsillitis)
  • anaemia

There are three stages of CML and the further down you go, the more CML becomes more like AML (Acute Myeloid Leukaemia).

Chronic Phase

This is the first stage of CML which usually lasts between 4-5 years and 85% of people are diagnosed within this phase. In the chronic phase there are 5% or fewer blast cells in the blood and bone marrow.

Pills can be taken to control the symptoms (imatinib) and it usually has a good response from patients but if it doesn’t, there are other drugs that people can take such as dasatinib and nilotinib.

If no treatment is taken or if the drugs did not work then the disease progresses to the accelerated phase.

Accelerated Phase

This phase usually lasts between 6-24 months.

In this phase, the number of abnormal cells in the bone marrow and bloodstream builds up. Many of the abnormal cells are ‘blast’ (immature) white blood cells and there are 6-30% blast cells in the blood and bone marrow.As these abnormal cells build up, it is hard for normal cells to develop and grow in the bone marrow to make enough normal blood cells. This causes other problems to occur:

  • Anaemia (due to the lack of red blood cells)- can cause tiredness, breathlessness and may look pale.
  • Blood-clotting problems (due to the low number of platelets)- can cause easy bruising, bleeding from the gums and other bleeding-related problems.
  • Serious infections (reduced number of normal white blood cells and abnormal white blood cells do not protect from infection)
  • Other symptoms may also include weight loss and pain due to enlarged spleen

Sometimes the chronic phase can skip the accelerated phase and may go straight to the third phase (blast phase).

Blast Phase

In this phase, the CML acts a lot more like Acute Myeloid Leukaemia (AML) as it rapidly gets worse. The symptoms above would worsen in this phase due to immature cells developing and filling the bone marrow and spilling into the bloodstream. There is a shorter survival rate for patients who have progressed to this stage.

The prognosis for this disease depends upon the overall health and age of the patient and how advanced the disease was. Only 1% of patients have died because of the progression of the leukaemia.

These are the sites I used for my research:

http://en.wikipedia.org/wiki/Chronic_myelogenous_leukemia

http://www.patient.co.uk/health/Leukaemia-Chronic-Myeloid.htm

I won’t give away the ending of my story- you will just have to wait until you find the novel on the shelves 😉

Rachel

 

Women in Medicine

I was reading the Student British Medical Journal (BMJ) and there was an article that really struck me. They had asked the question “Do you think wider society stills thinks of medicine as a more ‘male’ profession?”. The answer really surprised me as 60% of people had said yes where only 31% had said no. Being female myself, I am not prejudiced against woman taking a higher stance in the professional world and am very proud of what women have done in the past in order to get to where we are today and the response shocked me by thinking that things had not progressed as far as I had previously thought they had.

Dr James Barry (Margaret Ann Bulkley)

Dr James Barry (Margaret Ann Bulkley)

This made me think about the history of women in medicine and I did a little research. I came across some extraordinary findings that a woman (Margaret Ann Bulkley) had pretended to be a man, taking the name of her late uncle (James Barry), for 46 years in order for her to become a doctor. She had to do this due to the fact that no British medical school admitted women and her passion to become a doctor drove her to the extremes that she went to. I find it quite sad that any person would have to pretend to be someone they are not just because a group of people do not accept women in jobs in the field of medicine. It is also upsetting to know that no one knew who she really was despite all of her great achievements; not only was she the first woman to graduate as a medical doctor in 1812 (even if it was in secret), but she was also the first British surgeon to perform a successful Caesarean section, saving the lives of mother and baby. After six months as a pupil at St Thomas’ Hospital in London, Bulkley decided to join the army to continue her career as an army medical officer. To read more about her story, here is the link:
http://www.dailymail.co.uk/news/article-527128/Unmasked-Britains-female-doctor-pretended-man-46-years.html

Another important figurehead for women in the medical profession is Elizabeth Blackwell, the first openly identified woman to graduate from medical school on 23 January 1849. She had managed to secure the necessary school funds by taking a job as a music teacher and studied in secret by reading medical books and getting private tutoring from Dr Jonathon M Allen. She applied to 12 schools and despite all of the rejection and resistance being thrown at her, she was accepted into Geneva Medical College in New York.

Elizabeth Blackwell

Elizabeth Blackwell

After graduating, Blackwell decided to go to Europe to pursue her career and was met with a lot of hostility but also met with a few people who were voluntarily willing to work with her. She was mentored by Paul Dubois, a famous obstetrician, who voiced his opinion that she  would make the best obstetrician in the United States. Unfortunately, when she was treating an infant with ophthalmia neonatorum (a form of conjunctivitis contracted by newborns during delivery), she spurted some contaminated solution into her own eye accidentally, and contracted the infection. This caused her to become blind in her left eye ultimately destroying her chances to become a surgeon.

Elizabeth Blackwell then returned to the United States to open up her own practice. She was once again faced with resistance and did not have many patients. She published a couple of books and in 1874 was successful in opening the London School of Medicine for Women. She became quite successful and took other aspiring female doctors under her wing to train. Even in her late years, she was still quite active and even published an autobiography on her life in the medical profession.

Even after reading all of this, it still left me shocked to see the response and perhaps even more so. I understand that men and women are still not treated as equals and hopefully one day that will change but the work women had to put in to do something that men could easily grasp makes me slightly angry. Why should it be harder for women? It is probably because in the past men were seen as the doctors and women were only the nurses and things are still commonly seen this way; especially with the older generations. This made me think of the first episode of ‘Greys Anatomy’ where one of the interns called the main character (Meredith) a nurse despite knowing that she was a fellow surgeon. Men could be and probably were resentful to women partly because of their gender but also because they would have been a threat if they were better than them. I am glad that things are changing and it is acceptable for women to be doctors and even for men to be nurses but I wish that more of the wider society would keep up with the times and think in the same way.

Thanks for staying with me during my rant,

Rachel.

Human Embryonic Stem Cells Successful At Last!

On 15th May, a team of scientists at Oregon Health & Science University (lead by Shoukhrat Mitalipov) announced that they had successfully converted human skin cells into embryonic stem cells. They were created by SCNT (Somatic-Cell Nuclear Transfer) which is the same technique that was used in creating the first successful clone- Dolly the sheep.

In this process, the nucleus of the human egg cell is extracted and discarded, taking with it the DNA, and the donor skin cell’s nucleus is extracted and kept and then fused with the ‘host’ egg cell. This new cell is then shocked with electricity before it then starts to divide.

Extraction of nucleus of human egg cell

Extraction of nucleus of human egg cell

Human SCNT embryos- day 2

Human SCNT embryos- Day 2

 

After a lot of cell division (by mitosis), a blastocyst is formed (this is an early stage embryo containing around 100 cells). The blastocyst contains the exact DNA of the donor skin cell.

Single blastocyst of human SCNT

Single blastocyst of human SCNT

There is great controversy over this process and many argue that it is wrong, especially since it was revealed that 120 human embryos were destroyed in the process. The Church believes in protecting human life and this can be considered murder (in particular to Catholics who believe that life begins at conception). And although the university had said that they do not use fertilised embryos, others have said that as soon as human cells begin to divide into an embryo they are considered human life and to destroy this is immoral. I believe that as long as the embryos are used in a way to help medical advancements in a way that can save lives (like cloning cells to help in making new organs for those who are likely to reject a donated organ), this research should keep going and they should find a way to help those who are terminally ill and are in need of rescuing.

Another issue raised is that this method can be used for human cloning which is also considered unethical but Shoukhrat Mitalipov said that “our research is directed toward generating stem cells for use in future treatments to combat disease,” rather than for human reproductive cloning; he also believes that their research could not be used in aiding this type of cloning either.

On a more positive note, these human embryonic stem cells have been harvested from the cloned embryos and have been grown into beating heart cells! Here is a link to a video that shows these cells actually beating:

Beating heart cells

This is an amazing advancement in science and medicine and hopefully one day it will be considered an every day normal procedure in helping to cure the lives of those who need it.

I found my research on these sites:

http://www.guardian.co.uk/science/2013/may/15/human-embryonic-stem-cells-adult-tissue

http://ncronline.org/news/politics/researchers-embryonic-stem-cell-advance-decried-morally-troubling

http://en.wikipedia.org/wiki/Somatic-cell_nuclear_transfer

Paediatrics to Cardiothoracics…

I have wanted to be a surgeon for a long time and have wanted to be a paediatric surgeon for just a little bit less than that.

However, I recently read in the Student BMJ that paediatric surgeons only perform 11% of the surgeries on children; the rest are performed by the other specialties. When I heard this, I realised that I wanted to do more than that- therefore I researched the other specialties and I had always wanted to do something in cardio.

Because of this, I researched all about cardiothoracic surgeons and the journey I would have to take to get there.

You start with the 5 years studying medicine at university and then you spend 2 years in a hospital (foundation year 1 and 2). After those two years, you decide to take up surgery and begin your surgical training. The cardiothoracic specialty does not allow you to start training specifically in only that specialty and so you have to do 2 or 3 years doing general surgical training before you can apply to work in cardiothoracics.

Cardiothoracic surgery deals with illnesses of the heart, lungs, oesophagus and chest. These include cardiac surgery (heart and great vessels), thoracic surgery (organs within the thorax, excluding the heart), transplantation and heart failure surgery, oesophageal surgery and congenital surgery in adults and children. All procedures are usually major and often complex. Within cardiac surgery, coronary artery bypass grafting and valve operations and most commonly performed and within thoracic surgery, the most common operations are lobectomy or pneumonectomy for carcinoma of the lung (lung cancer).

cthome