Nobel prize in medicine - Part I

In 1893, Axel Key, Dean of the Karolinska Institute from 1886 until his retirement in 1897, undertook a second major journey to Europe and Russia, visiting distinguished scientists at various universities in many countries. He then, by chance, met Alfred Nobel in San Remo on the Italian Riviera. When he met Professor Key, Alfred Nobel mentioned his plans to found an international prize in medicine enabling the Karolinska Institute to reward experimental research within all domains of medicine. Key gave an account of his remarkable encounter with Nobel in a letter to this wife, which gives a fascinating picture of the times and a unique portrait of the shy and retiring Nobel

Nobel prize in medicine - Part II

After Alfred Nobel's death on 10[th] December 1896, the executors of his last will had a difficult task and the French State made attempts to consider Alfred Nobel's huge fortune as legally domiciled in France. The most notable of the Executive Directors was Ragnar Sohlman, a close personal friend and collaborator of Alfred Nobel during his last three years of life and one of the executors of his will. In this capacity, Mr Sohlman, who served the Nobel Foundation in various ways from its inception until his death in 1948, can be said to have embodied the spirit of Alfred Nobel. In May 1897, Sohlman contacted the leading men of Stockholm's Academy of Sciences, the Karolinska Institute and the Swedish Academy. With foresight Professor Key had drafted a well-argumented letter on behalf of the Karolinska Institute in favour of appreciative acceptance of Nobel's grand gratuity. The Nobel Foundation was established towards the end of 1897. The statutes governing the Foundation and the prize-awarding institutions were promulgated by the King-in-Council on June 29, 1900 and the first Prize ceremonies took place on 10 th December 1901. The temperament of Axel Key and Alfred Nobel disposed them to self-sacrifice in the service of mankind. On the occasion of the centenary of the first Nobel Prizes, it seems appropriate to pay attention to the two great Swedish contemporaries, Key and Nobel, who contributed so much to increase the international fame of the Karolinska Institute amongst researchers in medicine

Erust von Bergmann and the vasopressor response

Professor Ernst von Leyden from Konigsberg on the Baltic coast was able to monitor intracranial pressure [ICP] in dogs in 1866, recording bradycardia at critically raised ICP. Ernst von Bergmann [1836-1907] received his medical education in the more easterly located university town of Tartu in Estonia, where he was appointed professor of surgery in 1871. Along with a younger colleague he designed and performed a series of experiments. They theorized, in a medical thesis published in 1873, about the slowing of the pulse rate [PR] and an increase in carotid artery pressure with raised ICR In 1881, von Bergmann

Computerized tomography and subarachnoid haemorrhage

Aneurysmal subarachnoid haemorrhage [SAH] is a cerebral catastrophy, which has been known for centuries. It was not until the 1950s that the phenomenon of SAH-induced "cerebral vasospasm" of a delayed onset after haemorrhage was recognized by a few pioneers in the clinical neurosciences. Initially, like in so many other occasions in the history of medicine, this phenomenon was met with considerable scepticism by most specialists until it finally became well-recognized. Cerebral vasospasm [CVS] has two not-necessarily reconcilable definitions, i.e., radiographic vasospasm and clinical vasospasm or delayed ischaemic dysfunction [DID]. Since only larger arteries may be visualized angiographically, the diagnosis of arterial narrowing following SAH is limited to narrowing of these vessels which helps explain why the two conditions are not necessarily reconcilable. Radiographic CVS is identified in approximately 60% of arteriograms performed around the 7th day following an aneurysmal SAH, whereas symptomatic CVS [DID] occurs in approximately 30%, in half of the latter patients [15%] the deficit becomes permanent. With the introduction of computerized tomography [CT] it has become easier to diagnose SAH and CT has demonstrated that there is a correlation between the amount of extravasated blood on CT [Fisher SAH Grade] and the risk of developing CVS and DID. The pathogenesis of CVS and DID otherwise remains poorly understood

Cervical discectomy and acrylic discoplasty

Three patients with cervical disc protrusion and spinal cord/nerve root compression underwent anterior discectomy followed by acrylic discoplasty. The post-operative course was uneventful and the patients were mobilized on the day after surgery. The advantages of this procedure - to our knowledge not previously performed in the UAE - are described

Conservative management of C7 wedge fracture with locked facet C6-C7 in multitrauma patient

Problems involved in the management of a multitrauma patient, who also had a cervical spine fracture involving C6 and C7 without cord damage, are discussed. The patient's additional injuries proved to be a contraindication for internal fixation and fusion procedures as well as a more sophisticated external immobilization in a cumbersome halo vest apparatus

Sleep apnea with intestinal aganglionosis: report of three cases; therapeutic considerations

Hirschsprung's disease can be associated with other congenital abnormalities, some of which are neural in origin. A rare association is with congenital failure of automatic control of respiration-central hypoventilation syndrome, sleep apnoea or Ondine's curse. Patients with this combination tend to have a short life expectancy. Diaphragmatic pacing by electrophrenic stimulation has proven useful in the management of patients with central hypoventilation. Three children, two females and one male, with this combination are described. The male child, who had total intestinal aganglionosis, died at the age of one month despite an ileostomy and nocturnal mechanical ventilation. The two females had aganglionosis more typical of Hirschsprung's disease, one requiring colostomy. At the ages of two and six years, respectively, phrenic nerve stimulators were implanted. Both girls remained independent of nocturnal mechanical ventilation two and three years after the commencement of diaphragm pacing. In patients with Ondine's curse and Hirschsprung's disease, in whom the aganglionosis can be effectively managed, diaphragm pacing may lead to independence from mechanical ventilation and prolonged life with an acceptable quality