Dr. Vazquez Añón's last lesson

Summary This article is offered in homage to Dr. Vazquez Añón, one of the most out-standing Spanish plastic surgeons.It also is meant to draw attention to the need for a precise, detailed, and complete personality profile of each patient, requesting, in case of doubts, the help of a psychologist or psychiatrist.Dr. Vazquez Añón had frequently referred to the deep psychological problems sometimes involved in aesthetic plastic surgery, and his death is a warning to all of us.Unfortunately he gave his last lession with his life.     

Irving S. Cooper and his role in intracranial stimulation for movement disorders and epilepsy

Dr. Irving Cooper (1922-1985) was a pioneer in the field of functional neurosurgery. After years of treating patients with tremor by creating deep lesions with either anterior choroidal artery ligation or cryogenic thalamotomy, he began to utilize methods of electrical cerebral stimulation as treatment for a variety of disorders. Chronic cerebellar stimulation was employed for patients with epilepsy, cerebral palsy, and dystonia. While Dr. Cooper believed his results to be significant, there still remain many challenges to his claims. Later in his career, he placed deep brain electrodes in the internal capsule and thalamus for epilepsy and dystonia. His encouraging results from this small series were often overlooked. This paper reviews the science behind Dr. Cooper's work, his case series, and the controversies surrounding his results.     

Robert R. Shaw, MD: thoracic surgical hero, Afghanistan medical pioneer, champion for the patient, never a surgical society president

Dr Robert R. Shaw arrived in Dallas to practice Thoracic Surgery in 1937, as John Alexander's 7th Thoracic Surgical Resident from Michigan University Medical Center. Dr Shaw's modus operandi was, "You can accomplish almost anything, if you don't care who gets the credit." He was a remarkable individual who cared the most about the patient and very little about getting credit for himself. From 1937 to 1970, Dr Shaw established one of the largest lung cancer surgical centers in the world in Dallas, Texas. It was larger than M.D. Anderson and Memorial Sloan-Kettering Hospitals put together regarding the surgical treatment of lung cancer patients. To accomplish this, he had the help of Dr Donald L. Paulson, who trained at the Mayo Clinic and served as Chief of Thoracic Surgery at Brook Army Hospital during the Second World War. Following the War, because of his love for Texas, he ended up as a partner of Dr Shaw in Dallas. Together, they pursued the development of this very large surgical lung cancer center. Dr Shaw and his wife Ruth went to Afghanistan with Medico multiple times to teach men modern cardiac and thoracic surgery. They also served as consultants on Medico's Ship of Hope in Africa. Dr Shaw initiated multiple new operations including: 1) resection of Pancoast's cancer of the lung after preoperative irradiation; 2) upper lobe of the lung bronchoplasty, reattaching (and saving) the lower lobe to prevent the "disabling" pneumonectomy; and 3) resections of pulmonary mucoid impaction of the lung in asthmatics. Because of his humility and giving "the credit to others," Dr Shaw was never President of a major medical or surgical association.     

Breast reduction with dermoglandular flaps: Tessier's "total dermo-mastopexy" and the "yin-yang technique"

The use of dermoglandular flaps in reduction mastopexy was advocated by Paul Tessier, who never published his method, but had actually almost finished the following article before his death in June 2008. Dr. Tessier is acknowledged as the "father" of craniofacial surgery, but he had interest in aesthetic surgery, and was quite proud of the technique he had developed using dermoglandular flaps in reduction mammoplasty. He had literally hundreds of techniques and methods that he had developed but which never found their way into print, both because of his enormous surgical schedule, and perhaps his self-imposed standards for anything that he published, which were almost impossibly high. The technique proposed by Dr. Gargano is similar in some ways to Dr. Tessier, it seemed good that they will be published together.     

Outstanding contribution to pediatric anesthesiology: An interview with Dr. Robert H. Friesen

Dr. Robert H. Friesen, (1946–) Professor of Anesthesiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, has played a pivotal and pioneering role in the development of pediatric and congenital cardiac anesthesiology. His transformative research included the study of the hemodynamic effects of inhalational and intravenous anesthetic agents in the newborn and the effects of anesthetic agents on pulmonary vascular resistance in patients with pulmonary hypertension. As a model clinician‐scientist, educator, and administrator, he changed the practice of pediatric anesthesia and shaped the careers of hundreds of physicians‐in‐training, imbuing them with his core values of honesty, integrity, and responsibility. Based on a series of interviews with Dr. Friesen, this article reviews a career that advanced pediatric and congenital cardiac anesthesia during the formative years of the specialties.     

Follow-Up Study of the Use of Refrigerated Homogenous Bone Transplants in Orthopaedic Operations

Philip Duncan Wilson was born in Columbus, Ohio. His father was a family physician who held the Chair of Obstetrics in the Sterling Medical School [1]. The young Philip graduated from Harvard College in 1909 and then served as President of his graduating class at Harvard Medical School. He spent two years as a surgical intern at MGH, after which he returned to Columbus to practice. During WWI he was invited back to Boston to join the Harvard Unit under Harvey Cushing, and served with that unit when it was housed in the Lycée Pasteur. (The members of that unit included Marius Smith-Petersen, who also spent many years at the Massachusetts General Hospital and also became AAOS President.) He rejoined MGH on the staff in 1919. In 1925 he published an influential monograph with W.A. Cochrane (formerly of the Edinburgh Royal Infirmary), entitled, “Fractures and Dislocations” [5]. Toward the end of his years in Boston he helped found the American Academy of Orthopaedic Surgeons. In 1934 he was appointed as Surgeon-in-Chief at the Hospital for the Ruptured and Crippled in New York City. Dr. Wilson was active in many organizations, and reorganized and renamed the hospital he served (Hospital for Special Surgery), oversaw the building of a new hospital at its current site on the Cornell University medical campus, and raised money for a large research building. His zest inspired generations, and he was known for his gracious hospitality. Dr. Wilson was one of three of the first fifteen Presidents (the others being Drs. John C. Wilson, Sr. and Melvin Henderson) whose son (Dr. Philip D. Wilson, Jr.) succeeded him as a President of the American Academy of Orthopaedic Surgeons. Dr. Wilson had a long interest in bone grafting and wrote numerous research papers, a few of which are referenced here [2–4]. In the article reprinted in this issue [3], he described the rapid increase in use of a bone bank he developed at the Hospital for Special Surgery in 1946: 19 operations using grafts in 1946, 48 in 1947, 106 in 1948, 134 in 1949, and 259 in 1950. He describes his animal experiments with autogenous grafts in which grafts rapidly incorporated. He further describes biopsies of previously implanted autogenous and homogenous bone transplants in patients undergoing serial fusions for scoliosis. The pathologist (Dr. Milton Helpern) commented they found “...no evidence that the cells in the bone transplants survived...” Autogenous grafts, his evidence suggested, incorporated more rapidly that homogenous grafts, but “...in the end the results are the same.” His followup studies suggested successful incorporation of graft in 210 of 248 cases.

The development of a specialty: an interview with Dr. Mark C. Rogers,a pioneering pediatric intensivist

Dr. Mark C. Rogers (1942–), Professor of Anesthesiology, Critical Care Medicine, and Pediatrics at the Johns Hopkins University, was recruited by the Department of Pediatrics at Johns Hopkins Hospital in 1977 to become the first director of its pediatric intensive care unit. After the dean of the medical school appointed him to chair the Department of Anesthesia in 1979, Rogers changed the course and culture of the department. He renamed it the Department of Anesthesiology and Critical Care Medicine, and developed a long‐term strategy of excellence in clinical care, research, and education. However, throughout this period, he never lost his connection to pediatric intensive care. He has made numerous contributions to pediatric critical care medicine through research and his authoritative textbook, Rogers' Textbook of Pediatric Intensive Care. He established a training programme that has produced a plethora of leaders, helped develop the pediatric critical care board examination, and initiated the first World Congress of Pediatric Intensive Care. Based on a series of interviews with Dr. Rogers, this article reviews his influential career and the impact he made on developing pediatric critical care as a specialty.     

Part II. Personal Reminiscences

Personal reminiscences from one of Dr. John Gibbon's surgical residents are presented. A great attribute of Dr. Gibbon was his mastery of words, and he had a major interest in his role as editor of Annals of Surgery. He had a vast knowledge of all aspects of surgery as well as a deep understanding of the physiology of the human body. His approach to surgery was highly intellectual, and when he had accomplished one goal, he was ready to go on to something new. He and his wife Mary collaborated closely for 42 years, and they had a stimulating home life with their four children. He was ever young, energetic, and enthusiastic.     

The advancement of pediatric anesthesia pharmacology: David Ryan Cook (scions,serendipity, and six degrees of separation)

Dr David Ryan Cook, Professor Emeritus of Anesthesiology and Pharmacology at the University of Pittsburgh and Chief of Anesthesiology at Children's Hospital of Pittsburgh (1977‐1999), is a pioneer in the field of pediatric anesthesiology and pharmacology. Dr Cook contributed significantly to the understanding of pharmacologic differences among infants, children, and adults. His work as a clinician‐scientist, educator, and mentor defined the pharmacology of many of the anesthetic agents we continue to use today. He brought science to the art of anesthesia and enhanced the safety of pediatric perioperative care. Based on a 2017 interview with Dr Cook, this article outlines the development of his career and his contributions to the field of anesthesiology and pharmacology.     

Building an International Community of Paediatric Anaesthesiologists: An interview with Dr Edward Sumner

Dr Edward Sumner (1940) enjoyed a remarkably productive career as consultant pediatric anesthetist at the Great Ormond Street Hospital for Children. His leadership in clinical care helped his department rise to eminence. He trained hundreds of registrars in pediatric anesthesia and educated thousands more through invited lectures and by co‐editing leading textbooks of neonatal and pediatric anesthesia. During his long tenure as Editor‐in‐Chief of Pediatric Anesthesia, he led the growth of the young journal to prominence. Based on an interview and a long‐standing professional and personal friendship of forty‐four years, this article reviews Ted Sumner's outstanding contributions to the specialty of pediatric anesthesia and to the development of a strong international community of pediatric anesthesiologists.     

Medicine,Gabriel García Márquez,and Love in the Time of Cholera

The Nobel award-winning author Gabriel García Márquez (born 1927) originally released his book Love in the Time of Cholera in Colombia in 1985. For us physicians and surgeons this book contains lessons about medical humanities and the opportunity to apply them to our profession. Dr. Juvenal Urbino, one of the book's central figures, is a distinguished physician with impeccable training in Paris in the late 1870s to early 1880s. He returned to his native Colombian Caribbean coast to practice medicine and surgery. There his practice set an example for contemporary and future generations of physicians. Urbino was knowledgeable, dedicated, committed, studious, and well-intentioned. He mastered the humanities to the benefit of patients and society alike. He was an outstanding professor at the medical school and a favorite teacher to his attentive students. For all his good virtues, however, he did not serve the poor as much as he should have, possibly as a consequence of his opulent origin in the District of the Viceroys of his natal city. In short, Dr. Urbino brought to the medical profession a bright example of responsibility, professionalism, and integrity. Thus, he should be remembered as a physician and professor worthy of imitating in today's practice of medicine.     

Dr. Norman Bethune as a surgeon

Dr. Norman Bethune’s recognition as a Canadian of renown resulted from his devoted work in China during the late 1930s. He had received a general surgical training, but his personal illness with tuberculosis led him to specialize in thoracic surgery. A surgical program at McGill University under Dr. Edward Archibald, a pioneer thoracic surgeon, was initially successful, but by the mid-1930s Bethune was rejected by McGill and Dr. Archibald. He became chief of thoracic surgery at the Hôpital du Sacré-Coeur outside Montreal. He developed thoracic surgical instruments and wrote numerous scientific papers. The outbreak of civil war in Spain in 1937 attracted Bethune to oppose what he viewed as fascist aggression. He went to Spain, where he established the value of mobile blood banking. On his return to Canada in 1937 he became aware of the escalating war between China and Japan. He joined the Chinese communist forces in northern China and spent 18 months doing Herculean mobile war surgery, while improving the state of medical services in primitive, depressing conditions. He died in 1939 at the age of 49 years of septicemia as a result of accidental laceration of his finger during surgery. The Chinese have venerated Norman Bethune and stimulated his memorialization in Canada. His surgical record can be viewed as mixed in quality, but overall his performance remains impressive for its achievement.     

The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. ‘Fritz’ Berry

Dr. Frederic A. ‘Fritz’ Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians‐in‐training while advancing the field of pediatric anesthesiology.     

Diego Rivera and His Extraordinary Art of Medicine and Surgery

Diego Rivera (1886–1957), the superb Mexican muralist, made significant contributions to the art of medicine and surgery unmatched by any other painter of his stature in the world. Rivera intensively embraced medical and surgical knowledge through his legendary artistic career in a manner never seen before.

Rivera's first surgical theme can be traced to 1920, when he attended and drew the wonders of the surgical operation of Dr. Fauré in Paris. The artist was particularly moved by surgical and medical events, and this surgical clinic enhanced his appetite for these important professional activities. In 1932, Rivera introduced several medico-surgical panels in Detroit automobile industry frescos. Among them, vaccination, the human embryo, the pharmaceutical industry, the germ cell, and surgery are the most representative themes included.

Two years later, in Man, Controller of the Universe, the artist emphasized the effect disease and technology had on the rest of humanity. In 1944, Rivera produced The History of Cardiology, two movable extraordinary frescos that represent the history of this field of medicine. In 1953, the creative vein of this prodigious genius created The History of Medicine in Mexico, in which medicine and surgery are exceptionally well-conceived and analyzed. In brief, Rivera incorporated the best of his art and knowledge into the better understanding of medicine and surgery as he saw it during his outstanding artistic life.     

Part I. The Development of the First Successful Heart-Lung Machine

In 1931, after witnessing the death of a patient from pulmonary embolectomy, Dr. John Gibbon had an idea for a machine that could take deoxygenated blood, oxygenate it, and pump it back into the arterial system. Collaborating with his wife Mary, Dr. Gibbon worked from 1934 to 1942 to develop an extracorporeal circulatory device. By 1942, he was able to keep cats alive on his experimental devices, with continued survival after bypass. In 1950, he received support from IBM to build a heart-lung machine on a more sophisticated scale. Finally, on May 6, 1953, Dr. Gibbon performed his first successful operation using an extracorporeal circuit on an 18-year-old woman with a large atrial septal defect and a large left-to-right shunt.     

Early clinical xenotransplantation experiences—An interview with Thomas E. Starzl,MD, PhD

Dr Thomas E. Starzl, who died on March 4, 2017, was one of the great pioneers of organ transplantation. He was also a pioneer in the field of xenotransplantation. In 1964, he carried out baboon kidney transplants in six patients with terminal renal disease for whom no living or deceased donor became available; graft survival was for 19‐60 days, the grafts being lost largely through continuous complement activation. Between 1966 and 1974, he carried out one ex vivo liver perfusion and three orthotopic liver transplants using chimpanzees as sources of organs; graft survival was for <14 days. In 1992 and 1993, his team carried out baboon liver transplantation in two patients with cirrhosis from hepatitis B infection; graft survival was for 70 and 26 days, respectively. This early clinical experience is briefly discussed. Toward the end of his life, Dr Starzl was somewhat disillusioned by what he considered excessive regulation of medical research in the United States and believed that new advances were now likely to take place in countries such as China, where the regulatory framework is less developed.     

Further remembrances of that revered anatomist, Dr. J. C. Boileau Grant

From access to a detailed curriculum vitae written by Dr. Grant when he was about 75 years old, the author has learned some little-known facts of his background and life. His ancestors came from France and had been ennobled. One predecessor was a mayor of Paris. Several of his family decided to emigrate to Great Britain with the Huguenot movement. Grant graduated from the University of Edinburgh in 1908 in the same class as his future brother-in-law, William Boyd. When World War I was declared, he immediately volunteered for the army. During service on the Western Front, he was mentioned in dispatches in 1916, won the Military Cross in 1917 and a bar to the Military Cross in 1918. At the outbreak of World War II, Grant, who had been a professor of anatomy first in Winnipeg and then in Toronto for many years, volunteered again for war service, but was rejected as being too valuable a teacher to be allowed to enlist.     

THE COLONIAL CAREER OF JAMES PATRICK MURRAY

This paper is a biographical sketch of Dr. Murray during the years 1860 to 1873 when he lived in Victoria, New Zealand and the Pacific Islands. It records details of his career from his residency at the Melbourne Hospital followed by his exemplary conduct in the Howitt expedition to recover the remains of Burke and Wills. It traces his progress of degradation unhampered by constituted authority and concludes with his magnum opus– the greatest massacre of South Sea Islanders in the annals of the South Sea slave trade. He departed from the colonies still registered to practise medicine and without penalty or probation. This paper concludes with a brief summary of his personal qualities and asserts that it was these qualities, together perhaps with the discordance between the colonies, which allowed this knave to escape the penalty which he appeared amply to deserve.     

Baltasar Llopis Mínguez (1934-1990). Pionero en la investigación del cáncer vesical y en la introducción de la informática en Urología

ObjectiveTo recall the figure of a great Valencian urologist, to emphasize his great personality and humanity, and to draw particular attention to his significant contribution to the study of prognostic factors in urology and estimation of individual oncological risk, as well as to introduction of computing in urology.MethodHis work, the testimony of colleagues who treated him, and data obtained from his close relatives, as well as our own personal knowledge, are reviewed.ResultBaltasar Llopis was born in Valencia, and obtained his degree and doctorate in Medicine at the Valencia University. He specialized in urology with Dr. Tramoyeres Cases, for whom he acted as assistant surgeon and with whom he shared work at La Fe Hospital, where he carried out his complete urological activity, since its inception. Dr. Llopis opted for oncological research, with a special focus on urothelial tumors. He pioneered diagnosis of these tumors using tumor markers and the study of prognostic factors to assess the individual risk of relapse and to implement a specific chemotherapeutic treatment, which he introduced in clinical practice at La Fe Hospital. He thus demonstrated the two essential components of his personality, his investigative and human sides.ConclusionA multi-faceted person with great skills and intelligence, Dr. Llopis eagerly devoted himself to research aimed at understanding the biological behavior of cancer, particularly urothelial tumors. In the early 80s he pioneered worldwide the development of specific markers, estimations of individual oncological risk, and prognostic factors useful for planning treatment. He was 20 years ahead of the era of predictive nomograms and their clinical Introduction In addition to being a forerunner of computing applications in Urology, he designed a database for registration of superficial bladder tumors, which allowed him to perform statistical and multivariate analyses using multiple regression models to predict the risk of relapse.