Friday, November 14, 2008

Medicine In The 80's: Dead Then, Alive Now

Some might think of the 80s to be the period of cheesy haircuts, fuzzy neons and a constantly morphing Michel Jackson. To many, they still feel fresh and recent. There are many fields that have flourished significantly since the 80s. There is no need to emphasize how much has changed in the world of information technology since most of you are most likely well versed in that. However, many do not realize the humongous leaps that Medicine took during the past 25 years. Here, I will list a fraction of the major medical advancements that may have escaped many people, simply because they are currently taken for granted, but had you suffered from a condition that warranted some of those medical interventions, you most likely would have not received them then.

Cardiac Stents:

Cardiac catheterization is a procedure where a cardiologist inserts a catheter into a peripheral artery or vein and follows the path of that vessel retrogradely until he reaches one of the chambers of the heart connected to that vessel. What you might recognize mostly is the procedure we currently get if someone has a heart attack. Doctors who examine a heart attack patient (a.k.a. Myocardial infarction), would like to take a look at the patency of the arteries that feed your heart, we call the coronary arteries.

This whole idea was actually first devised in 1939 by Werner Forssmann. So you might ask yourself, what changed since the 80s? Stents. Prior to 1989, the main purpose of catheterization was to visualize and diagnose; they were also somewhat therapeutic by the use of balloons. Basically the catheter reaches to a clogged region of the coronary, and inflates a soft balloon to widen the lumen of the artery. That procedure was deemed inferior to what then used to be a very common surgery called coronary artery bypass graphting (CABG), which basically strips non-essential veins from the legs to be used to reconnect the area after a certain clog in the coronary to a major vessel, thereby resupplying the starved heart muscle with much needed blood. What that surgery meant was that a patient had to undergo a very risky operation where the chest is split wide open, the heart is frozen to a temperature close to zero, and the body for the duration of the surgery was supplied by blood via an artificial machine.

Stents are a small scaffold like structure that can be inserted into a clogged artery and placed to support the walls of the vessel after it has been ballooned, to keep it patent. Studies showed that there was no extra benefit for surgery over stents in many patients that would have received a chest splitting, heart freezing surgery. Instead, all what patients have to undergo now is go into a catheterization room for around 30 minutes, have a small incision in their right or left thighs, and have the catheter place a balloon and stent in a clogged coronary. Patients usually stay awake for the duration of the procedure. Stents were first reported to have been used in heart vessels in 1986 but it was not until 1989 when the Palmaz-Schatz balloon-expandable intracoronary stent was developed, when it went mainstream. It is said to have reduced the number of cardiac surgeries by more than 60% since the 80s. Amazing? I say Aye.

Laparoscopic Cholecystectomy (Removal of the Gall bladder by scopes):

Stones, they are everywhere, in your garden, on your lawn, in the hands of kids in Palestine and in your gallbladder. Those pesky little pebbles of annoyance have many causes, and vary in nature depending on the region. But in the developed world, the most common are cholesterol stones. No surprise there.

The incidence of gall stones is around 10% of the population averaged for both females and males. They are obviously extremely common. Those stones can stay in the gall bladder for years undetected. They get noticed when they cause complications, mainly when they clogged bile ducts that come out of the gall bladder and liver, leading to many dangerous conditions such as inflammation of the gallbladder (Cholecystitis) and inflammation of the pancreas (Pancreatitis).

So if those little buggers needed to be removed, what had to be done? Basically, patients had to undergo a major operation, slashing the right half of your upper abdomen open. In addition it entailed a long stay at the hospital.

Laparoscopy is a procedure which uses mechanical aids and a fiber optic camera through very small well placed puncture holes in the abdomen, to be able to manipulate and/or remove contents in the abdomen. Laparoscopic Cholecystectomy is the use of that method to remove the gall bladder. This procedure was first popularized in the US by Dr. Eddie Joe Reddick in 1989. Now it takes around 15 minutes to get rid of your gallbladder. Only 5% of all laparoscopic gallbladder surgeries may warrant the surgeon to convert to an open procedure.

From an abdomen slashing multi-hour surgery, to a few puncture wounds you won’t notice done in 15 minutes. Amazing? I say aye.

Blood transfusion screening:

Hepatitis C and HIV are major life shortening illnesses that debilitate the world. Needless to say, any method to achieve a reduction in the number of infected people is more than welcome. Prior to the mid 80s, none of the blood products used in blood transfusion were screened for either HIV or Hepatits C.

What this meant, was basically that a person who just sustained a major trauma, or a person who is simply going into an operation for a repairable problem, could end up coming out with a major life threatening illness had s/he needed a simple blood transfusion. Screening for HIV was not even developed to the lat 1980s, and screening for Hepatitis C was not a standard until 1992. Thanks to screening, this has improved significantly. It is next to impossible to receive any of those infections through a simple blood transfusion currently. Essential? I say aye.

The Internet:

Yes folks, the intewebs. Aside from the fact that you can troll websites with false links to tits, and the almighty Porn, it actually can save lives. The applications are virtually limitless, and the benefits to mankind are humungous.

Simple things that we take for granted were virtually impossible in the 80s. Medical students can have access to what is equal to a library that could fill all floors of many skyscrapers. All of that knowledge can be accessed right from within one’s room. Updates, advancement and research in medicine were facilitated and catalyzed through the internet.

Other applications include the availability of correct health information to Patients who seek to know more about their conditions. In addition, radiologists could examine images from their homes if an emergency rises and they cannot be physically available at the hospital. A novel procedure could now be demonstrated live to the whole world, instead to only the few select people that could fit inside the operations room. The standards of care extended to virtually all the regions that have access to the web, giving a new meaning to the word "standard". The benefits are clearly limitless. Amazing? I say aye.


With this I conclude this article. Obviously I missed some major medical advancements, such as Genetic engineering, Cancer treatment and HIV anti-retroviral medications. Boring you is not my objective. If you were bored, I apologize. If you weren’t, I am glad. Either way, I thank you for reading all the way to this sentence.

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