Archives: 10/2005

Note: The Good Old Days is our regular Friday column. It is presented today as a special for Halloween.
On this Halloween, we present a story that starts as a tale of the macabre, and evolves into star-studded massacre.
It’s the tale of the first riot in the young United States, a riot not about taxes or whiskey but cadavers, and the inappropriate procurement of them. We turn to the writings of Dr. John Wilson:

The Doctors Mob, one of the most violent outbreaks of civil unrest in early American history, was a furious response to the common practice of obtaining cadavers for anatomical dissection by robbing graves. This hazardous and loathesome business, made necessary by the gross inadequacy of legal provisions for obtaining cadavers for medical instruction, was carried out by a disparate group, generally referred to as “resurrectionists.” Medical students and teachers of anatomy were frequently involved in grave robbing, and there was a more or less disreputable assortment of entrepreneurs who sold cadavers to medical schools or private teachers of anatomy.
Resurrectionists preferred to rob the graves of the poor, the unknown, and enslaved Blacks as least likely to be noticed and cause public outcry; but no graves were exempt unless there was some protection such as an iron coffin, a vault, or a watchman standing guard with a shotgun from dusk to dawn for two weeks, after which the corpse was so decomposed as to be of little use for dissection.
Grave robbing at its best was a complicated and dangerous undertaking that required careful planning to avoid detection, and considerable skill to complete the task with dispatch. Two strong men, two large canvas tarpaulins, digging tools, and a dark lantern to light the scene but invisible from a distance, were the essentials. Dirt was removed from only the head end of the coffin and placed on one of the tarpaulins. After silently breaking through the lid of the coffin, weakened by a row of holes bored across it, the corpse was hauled up by a hook inserted under the chin or, alternatively, by a rope attached to a ring on the back of a harness strapped under the arms. The body was then stripped of all clothing and wrapped in the other tarpaulin. The clothes were thrown back into the coffin, the excavated dirt returned to the grave, and its surface restored exactly to its prior appearance to disarm suspicion of tampering.
trinity Doctors, Cadavers, and Americas First Riot
In the hands of experts, the over-all job required about an hour. The deceased, wrapped in the tarpaulin, was placed in a wagon, whose inconspicuous drive past the graveyard was carefully timed to coincide with the completion of the disinterment, and thence the cadaver was delivered to the medical school through a clandestine entrance. Bodies were usually procured during the cool season from November to February when anatomy courses were given, and were dissected immediately because embalming was not in use, putrefaction progressed rapidly, and discovery was always to be feared.

How did this particular uprising occur? Legend suggests its genesis was a series of unfortunate events starting on April 13, 1788, at the old New York Hospital in lower Manhattan:

(more…)

draper Predicting Fracture with LasersThere’s a new, more complete way to image bone strength. Instead of just relying on X-rays of the mineral phase of bone, lasers can quantify the organic phase. This press release from researchers at the Imperial College of London explains further:

Although X-rays can be used to measure bone strength, they can only be used to measure bone mineral density, which only accounts for part of the strength. The new Raman spectroscopic technique allows scientists to measure the collagen, which also affects bone strength by eliminating the spectral components of overlying tissues.
The scientists plan to develop this work into a test for women during adolescence to predict the likelihood of osteoporosis developing in later life. By taking steps earlier on, such as increasing exercise to build up bone mass, this could prevent the need for more interventions such as Risedronate (Actonel) later.

More from Dr. Edward Draper

UT First Contact with a Universal TranslatorDo you remember how everyone on Star Trek could immediately communicate with new aliens? Casual viewers just dismissed it as lazy writing, but the hardcore fans knew otherwise — everyone on the show had a tiny “universal translator” implant that decoded foreign languages in realtime.
That always seemed fanciful to us, but now researchers at Carnegie Mellon are making it happen. The Pittsburgh Post-Gazette has more:

Mr. Jou, a graduate student in language technologies at Carnegie Mellon University, was simply mouthing words in his native Mandarin Chinese. But 11 electrodes attached to his face and neck detected his muscle movements, enabling a computer program to figure out what he was trying to say and then translate his Mandarin into English.
The result boomed out of a loudspeaker a few seconds later:
“Let me introduce our new prototype,” a synthesized voice announced. “You can speak in Mandarin and it translates into English or Spanish.”

It’s not clear to us why he was photographed drinking bottled water. Maybe his device is advanced enough to translate “Perrier” from the French.
More from Szu-Chen Jou’s page at Carnegie Mellon…
Hat tip: WMMNA

sand tag 2 The Athena Radar Responsive TagThe Athena Radar-Responsive Tag is not strictly speaking a medical device, but rather a military safety gadget to prevent friendly fire casualties. Developed by the Sandia National Laboratories, along with General Atomics Aeronautical Systems, Inc. and Sierra Monolithics Inc., the system has just been tested during Exercise “Urgent Quest” in the United Kingdom.

During the demonstration, Athena tags were placed on military vehicles participating in the exercises. The device, tracked via aircraft radar, can be used to identify both U.S. and coalition forces during combat to avoid fratricide. During war, fratricide is the act of killing one’s own soldiers.
Aircraft on bombing runs used their on-board radar systems to ensure there were no friendly troops in their sights. If an Athena-tagged vehicle was present, a unique identifier appeared on the pilot’s screen alerting him to a friendly force in his target area, thereby avoiding a potential friendly fire incident.
sand tag 1 The Athena Radar Responsive TagIn preparation for Exercise Urgent Quest, the Athena tag has been demonstrated with several U.S. and European aircraft. In addition to combat identification, the tag can be used for blue force tracking, a similar but not identical mission.
Sandia Project administrator Darick Lewis says the exercises were intended to evaluate the effectiveness of various technologies in preventing friendly fire.
“Ideally, worthy candidate technologies can be transitioned into final development programs and produced for warfighter use,” he says. “Athena is effective because it utilizes a fighter aircraft’s existing radar for detection. It is simple, rugged, small and inexpensive to integrate.”

The Sandia press release

The Fraunhofer Institute for Biomedical Engineering IBMT has developed a modified femtosecond laser system that has already been clinically tested for the diagnosis of melanomas, and is expected to be employed in the future for a wide variety of diagnostic and treatment modalities:

One in two short- or long-sighted adults could be treated by a laser operation, and femtosecond lasers are being increasingly used. This type of laser can be focused through the tissue directly onto the working area, saving time and improving the healing process. There is a disadvantage, however: residual radiation permeates the eye right through to the retina, and may cause impaired vision. Karsten König and his team at the Fraunhofer Institute for Biomedical Engineering IBMT are working on eliminating these side effects. “We are attempting to remove tissue constituents gently and very precisely using extremely low pulse energies of just a few nanojoules,” explains König. This is made possible by a heavily modified femtosecond laser system with a very high pulse sequence, which can focus its beam with great accuracy using precision optics from Zeiss.
The laser paves the way for entry into nanolaser medicine, a new branch dealing with the diagnosis and therapy of individual cells. Depending on the laser power and optics used, the system can be a “femtoscope” providing insights into living tissue which are a thousand times more precise than the best computer tomographs. It is also a precision tool. The team of research scientists succeeded in performing the world’s smallest incision into living tissue – with a width of just 70 nanometers. This opens up new possibilities: gene transfer by light, in which foreign genetic material is inserted into living cells using ultra-short laser pulses, without destroying the cells. “In this way we can introduce pharmaceutical agents or genes into individual cells,” emphasises König. He has been awarded the new Technology Prize for his human-centered technology.
The first application – diagnosis and therapy of melanomas – was realized in cooperation with dermatologists at Jena University Hospital. The “femtoscope” renders the cell layers of the skin visible. Diseased cells are diagnosed by comparing samples. In future, doctors could use the same device for treatment: The diseased cell would be radiated with increased laser power and destroyed. After approval of the process, it would no longer be necessary to perform biopsies and time-consuming histological tests.

The Fraunhofer Institute for Biomedical Engineering IBMT homepage

xilas temp TempTouch® for Diabetics
The San Antonio Express-News is reporting that a local company, Xilas Medical, Inc will be honored at the 2005 Stars of Innovation Gala, an event hosted by the San Antonio Technology Accelerator Initiative. The company makes a number of medgadgets to diagnose and prevent diabetic neuropathy and its complications. TempTouch® by Xilas has caught our attention.
According to Express-News, TempTouch® is a “wandlike thermometer for diabetics who have nerve damage to check for “hot spots” or inflammation on the bottoms of their feet.”
From the company’s website:

TempTouch® provides the patient with an “early warning” of inflammation and potential ulceration. Our product is designed as a non-invasive, predictive, self-management tool to be used at home by the patient on a daily basis. The methodology used in previous clinical trials was to compare temperatures of one foot to the other in like positions. TempTouch® has been proven highly effective in NIH-sponsored clinical trials in detecting inflammation which occurs before an ulcer actually breaks the surface of the skin. Once the inflammation has been detected, patients are able to off-load and/or reduce activity levels to avoid more serious problems such as ulceration. A prescription form is required for the instrument…

A simple instrument to prevent serious problems. Cleared by the FDA since March.
More here

Dr. RW Donnell points out a Wikipedia article about evidence based medicine. A nice intro for the common folk.

Researchers from Yale have achieved a breakthrough in the genetics of reading disorders. On chromosome 6, they’ve identified a gene called DCDC2 and linked it to dyslexia:

Dr. Gruen and co-authors used a statistical approach to study and compare specific DNA markers in 153 dyslexic families. “We now have strong statistical evidence that a large number of dyslexic cases – perhaps as many as 20 percent – are due to the DCDC2 gene,” said Gruen. “The genetic alteration on this chromosome is a large deletion of a regulatory region. The gene itself is expressed in reading centers of the brain where it modulates migration of neurons. This very architecture of the brain circuitry is necessary for normal reading.”
To facilitate reading, brain circuits need to communicate with each other. In reading disabilities, these circuits are disrupted. In people with dyslexia, compensatory brain circuits are inefficient and they have a hard time learning to read.

The research effort was thwarted for years, until it was discovered that scientists were accidentally studying gene CDCD2.
More from Dr. Gruen’s laboratory

HCA Inc. is the first of what might be many hospital chains offering doctors a portion of the savings by chosing a less expensive option when it comes to implants (mostly orthopedic implants at this point). Termed “gain sharing,” the idea has device manufacturers pitted against hospitals and US regulators trying to cut Medicare costs. Reuters reports:

“We want to be careful it doesn’t result in just putting in cheap implants and going to the lowest common denominator,” Stryker Corp. Chief Executive Stephen MacMillan said this week at the Cleveland Clinic’s Medical Innovation Summit.
Gain-sharing can involve various types of cost-cutting. Under one version, hospitals provide doctors with financial incentives to switch to an approved vendor to give the hospital more leverage in contract negotiations with the device maker.
Analysts say the deals could lead to pricing pressure for device makers, who have enjoyed price gains of about 3 percent to 5 percent a year for several years.
But the U.S. Department of Health and Human Services inspector general has approved seven plans it said were carefully crafted to protect patients, and it is considering another proposal by HCA Inc.
But the U.S. Department of Health and Human Services inspector general has approved seven plans it said were carefully crafted to protect patients, and it is considering another proposal by HCA Inc.
HCA has entered into gain-sharing contracts with three orthopedic device makers — Stryker, Zimmer Holdings Inc. and Johnson & Johnson’s DePuy unit, HCA spokesman Jeff Prescott said.
“We had a panel of orthopedic physicians describe to us the best devices, and we then approached those manufacturers, thus ensuring that those on contract were recognized as producing high-quality devices,” Prescott said.
Several protections were included, such as requiring a review of patient outcomes, Prescott said.

Doctors traditionally hate having their choices regulated by administrative types, so offering incentives to go with a cheaper option certainly beats forcing the cheapest option on them. However, if hospitals can offer doctors “gain sharing” for going with a cheaper implant, can device companies offer “gain sharing” for going with a more expensive one?